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HomeMy WebLinkAboutMiscellaneous - 393 MAIN STREET 4/30/2018N2 9.6 9 6 to CHU This certifies that has permission to perform Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING plumbing in the buildings pf if! ��YA VS('j ................. I , 4�5f . at. V pa ... .... I North Andover, Mass. ........... Fee. .... Lic. No.�O:��O. . M.� ......... Check 'q ) $&I) PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY( tl-'`�-- I MA DATE /2 _{?- j PERMIT# JOBSITE ADDRESS 3 2, �,t`,�/ �� 1 OWNER'S NAME POWNER ADDRESS TEL _ FAX z I' TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL D RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: , PLANS SUBMITTED: YES ® NO FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 1_,. 1_._-..2. 1 1__. 4 BATHTUB CROSS CONNECTION DEVICE _..._.....1_. DEDICATED SPECIAL WASTE SYSTEM __..-._8_._ oDEDICATED GAS/OIL/SAND SYSTEM .-. __._. DEDICATED GREASE SYSTEM .__._.-.._7...__._:__-...._._.._....9__._... ._. DEDICATED GRAY WATER SYSTEM ._.._1._..__.__0 _._. ___ _(i DEDICATED WATER RECYCLE SYSTEM ! ...__..... _ _TT3 _.. ._.11fIi( DISHWASHER DRINKING FOUNTAIN �_..f ..-._.....4 ______► .____-_! ____.._I FOOD DISPOSER..._.__.(....._( FLOOR/ AREA DRAIN .- -------- --..._INTERCEPTOR(INTERIOR INTERCEPTOR (INTERIOR KITCHEN SINK _ .-...._1 _4 LAVATORY( --..__.....I __._._..� (---_....._( ..._....._.__ ._._._._.l :----_.-._I ► _-__.__...1 _..__-.( ._.._.......1 _..__.__.f _ .__..__I ___.__._( ROOF DRAIN SHMA RSTALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING _I OTHER I • I � I INSURANCE COVERAGE: I have a current liab_ ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ._ ., NO _ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND 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 Ej AGENT J[.] SIGNATURE OF OWNER OR AGENT f hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of y know edge and that all plumbing work and installations performed under the permit issued for this application will be in ompli nce ith all P inept pro ion o e Wlassachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _,-^-ai�-.emu -l- II j LICENSE# D--_} NATURE MP Ej JPCORPORATION[3# -31 V- --j PARTNERSHIP[ #=LLC Q# COMPANY NAME , �S ,�k c ADDRESS1-1 CITY ojQ, 1j11V dt7,-,, 4 ;ISTATE a-4- - I ZIP 10 IF ` TEL 7 8 .�j T d FAX w� C EMAIL ...1_h_.J.1�7� --_ o Ej z N ❑ LLI w is t. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 U www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: f.)o ON City/State/Zip: U , �� "+Phone #: 1-2 9- CD Are you an employer? Check the appropriate L [4r—)---_ box: am. a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ 1 am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance reauired-1 Type of project (required): 6. ❑ Ne construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing 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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information, am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site nformation. nsurance Company Name: 2i /) V-2,� e J 'olicy # or Self -ins. Lic. #: Expiration Date: ob Site Address: City/State/Zip: Ikttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a he 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 f up to $250.00 a day against the violator. Be' advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certi under the pains andpepaltieyfperjury that the information provided above is true and correct. D1— 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 /-2-/ � / / --Z-- Contact Person: Phone #: tv t:J 0,:. ;V., cn. to M "A > U) U) 01 Ssgnature; 7547 Date.//(j/�/ .......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SS CHU This certifies that ... 0. . ..... T .......... has permission for gas installation . . . ................ in the buildings of . . r�?A -I . 7�� 4.,% �q. . North Andover, Mass. at . ?. ?. Fee:?f�.—.. Lic. No.. /4 GAS I N9 PEIC-�O�R i Check# FIYTI IRC W MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CO) City/Town: �%G l'�J�c�rJ -j '• MA. Date: / Permit# r Building Location: Owners Name: � C6 Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ®"-- Plans Submitted: Yes ❑ No ❑ FIYTI IRC W CO) C6 LU ~N Q N ULu = 0 O Ito F U) w Z I- QOQ W Z U) ac 0 g W U) W W W Z m 0 Q a H Q 0 W X W W' V w (i 0 = W 0 Lu CO = = li oc w W Z J 1— QIQ— 0 Z J 0 IL W W W W 0 D LL. 0 0__ O a H > O SUB BSMT. BASEMENT 1 FLOOR 2 ND FLOOR 3 FLOOR 4 FLOOR PF -FLOOR -i 'FLOOR 7 TH FLOOR 811-1 FLOOR Check One Only Certificate # Installing Company Name: 514 A. El Corporation Address: S -b i3 6A rt, 4- va''" City/Town: -?10 a..`. State: 41 2, ❑ Partnership Business Tel: ) Fl G-tl, og, Fax: E3-Firm/Company Name of Licensed Piumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes []'No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑'�- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner El Agent E] By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the nest or my r%nowieoge ana tnat all piumbmg work and installations performed under the permit issued for this application will be in wmpnance win au rertment provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Typp_of License: El Plumber Title ❑ Gas Fitter Signature of L censed Plumber/Gas Fitter 0 -Master City/Town ❑Journeyman License Number: ?,7 APPROVED OFFICE USE ONLY El LP Installer 6 Date. TOWN OF NORTH PERMIT FOR ( This certifies that ....... .................. has permission for gas installation L,4-. . 1-� ................... in the buildings of ........ ................ at North Andover, Mass. Fee.?.�,- Lic. No.k��( .... .... INSPECTORf Check # V 3 1 MASSACHUSETTS UNDDRM APPUCATON FOR PERMIT TO DO GAS FMING (Type or print) Date S-11 Z -/d NORTH ANDOVER, MASSACHUSETTS , Building Locations Permit # l y l al Amount Owner's Name New Renovation Replacement Plans Submitted (Print or type) Name •, V Address usmess 4 �rr J-1 "J U ✓.2dL ci�7 i Name of Licensed Plumber�or Gas Fitter Check one: Certificate Installing Company 0 Corp. ElPartner. 0irm/Co. INSURANCE COVERAGE Checkone• I have a current liability Insurance, policy or it's substantial equivalent. Yes No� If you have checked Vis, please in ' to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ED Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner [3 Agent 13 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and in5&1"s performed under Permit lssu9d for this application will be in compliance with all pertinent provisions of the Mass usetts ate Gakode and Choter 14 of the Gpigral Laws. By: Title y City/Town; APPROVED (OFFICE USE ONLY) Si nature of Licensed Plumber Or Gas Fitte Plumber Gas Fitter License NurnUer 0-1blaster Journeyman WW a M. z H U x z �' '� > a z Q x a a wa a w o H A H w x z w a �' co CQ zz o z w o x o x 3 c o > o a SU B-BASEM ENT 4 o BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type) Name •, V Address usmess 4 �rr J-1 "J U ✓.2dL ci�7 i Name of Licensed Plumber�or Gas Fitter Check one: Certificate Installing Company 0 Corp. ElPartner. 0irm/Co. INSURANCE COVERAGE Checkone• I have a current liability Insurance, policy or it's substantial equivalent. Yes No� If you have checked Vis, please in ' to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ED Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner [3 Agent 13 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and in5&1"s performed under Permit lssu9d for this application will be in compliance with all pertinent provisions of the Mass usetts ate Gakode and Choter 14 of the Gpigral Laws. By: Title y City/Town; APPROVED (OFFICE USE ONLY) Si nature of Licensed Plumber Or Gas Fitte Plumber Gas Fitter License NurnUer 0-1blaster Journeyman tIT INO. o APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MAP iqO. LOT NO. I 2 RECORD OF OWNERSHIP JDATE BOOK iPAGE ZONE SUB DIV. LOT NO. �l M �.747,c LOCATION ��Sg _ PURPOSE OF BUILDING OWNER'S NAME yy NO. OF STORIES SIZE OWNER'S ADDRESS J J / BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW A/O SIZE OF FOOTING X IS BUILDING ADDITION A --la MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER yrs BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS I - 3 PAGE 2 FILL OUT SECTIONS I - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED_ -//a� SIGrTURE OF OWNER OR #tVTHORIZED AGENT OWNER TEL. # 9 -?d2d F E Ems. CONTR. TEL. #_.__ CONTR. LIC. # PERMIT GRANTED 5� L Vi �9 In 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 5&y-0, EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN / o��w�nw ins vR 1 OCCUPANCY SINGLE FAMILY I STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL K. PINE BRICK OR STONE H RDW— _ PIERS PLASTER DRY WALL — — _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA _ 1/1 1/1 1/1 FIN. ATTIC AREA N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE EARTH B 1 2 3 _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDVJ'D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I- I POOR ADEQUATE. NONE 5 ROOF 10 PLUMBING GABLE GAMBREL I HIP BATH I3 FIX.) MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC _ 10 13rd NO HEATING BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. Loc3Mon N o. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 4'10 Foundation Permit Fee A-1 $ OthYAtim it Fee $ �ta000l%ker Connection Fee $ laW.,Gonnection Fee j 270TAL Building Inspector Div. Public Works � � � � �# I Rm . q$O D W O 2�k 0w w aw cic co k02 0 W:c /\\ / -Jw U� «(rWa SL) wmcr . . @M < w \. �2k.3 0Zk. 2 a kLL XZ w>W ®bD C,)wq 0 ZW$k wccw0 «EE .�wMZ > � /50E | 0 Z W G Z Q 0 Z LL O Z 3 0 69 69 69 N cc d a E ti � m v a- 0 m o a or - cc U C U75 m Ii 69 64 CD U- E a m t Fo m U- r - 0 c0 U OD c r- 0 U `m m U `o U m a C C cm C v_ B � N H 69 69 69 N cc d a E ti � m v a- 0 m o a or - cc U C U75 m Ii 69 64 CD U- E a m t Fo m U- r - 0 c0 U OD c r- 0 U `m m U `o U m a C C cm C v_ ,-," �L w Z �a LU Cie CQ cc ac Bd� O O z �L w Z �a LU c 0 C a� _V �a a as r sr. O E a t +.r 0 8 w c O v aui CL is V v C d C6 s QD c C6 u v O c W a O t as Z u a N Cie cc ac � O .= O� E a 4 0 y C rrrrrr� of C *00 C WW 0 a. E W a ~ 0: og 3 3 o C H Z ._ {i Z ? Z WWA Co V 0 C � r.r CL to Z Z V ? *00 tv cc ami o mW. u c7 0 m m L C J t Lu t U t m a E d rn W a a m �[ O L c o c o m Co o c j -E CC U IL cc LL Q CO) U- U. m (A c 0 C a� _V �a a as r sr. O E a t +.r 0 8 w c O v aui CL is V v C d C6 s QD c C6 u v O c W a O t as Z u a N o 0 Z N � O .= a E a 4 0 y C rrrrrr� C *00 bn a. E c a og 3 3 o C C Z ._ C O Co V 0 C � r.r CL to *00 tv ami o 0 Z N 1b Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE 5 21Z - JOB LOCATION 3Jr`3 j'yj�� �_S 7 Number Street Ad :'HOMEOWNER" IHI ress ection of town ame Home Phone Work PRESENT MAILING ADDRESS) one City Town State Gip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwell- ing, attached or detached structures accessory to such use and/or farm ,structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building•Department mum inspection procedures and requirements and that he/she wi comp y with said procedures and requirements. HOMEOWNER'S SIGNATURE .APPROVAL OF BUILDING OFFI Note: Three family dwellings 35,000 cubic feet, or larger, will be \ required to comply with State Building Code Section 127.0, Construction Control. N2 4C74 Date .1. 1,.".-.-. .1. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... f // ........... /. .................. has permission to perform ....... plumbing in the buildings of ............... at ... �`7. 3. / ........... I North Andover, Mass. Fee. . Lic. No.. ............ ...... P�UMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept PINK: Treasurer L) - MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 3 73 ✓iy 57. Ow Of Date /h Z.� C_ t' Permit # Amount - � 7 r New Renovation Replacement Ej Plans Submitted Yes No El FIXTURES (Print or type) Check one: Certificate Installing Company Name i✓t6/'%r/� �//���y Corp. Address �9� ��"�''' ✓� ac 5111" 'W-//, Partner. Business Telephone Fimi/CO. fr ? cf Name of.Licensed Plumber. m Insurance CovernQe: Indicate the of insurance coverage bVI checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have anyone of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plun}bjng Code an_cLC-4qpter 142 oaf the f eneral La*s. !City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License tcense VqLm r Master Ioumeyman Location 3 ?,_3 4)1,1 1A) 'Si - No. (3jD - Date e<- 4�1-0��O/ Check # 4 6 21 5 Building Inspector TOWN OF NORTH ANDOVER Certificate of Occupancy $ C U Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 4 6 21 5 Building Inspector 4 TOWN OF NORTH ANDOVER - BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING _ .: J t✓,s 's � t>� � � � S,� � � zi'aE1A1 �1�1 zs x a �n.. _ ":..�» BUILDING PERMIT NUMBER: DATE ISSUED: 6— `—& QDO SIGNATURE: C LC,1� Building Commissioner/IEECEtor of Buildings Date CT rmi�it oma iavl. 1- JllE ll1rUKMA11UN I A Property Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number Name (Print) Address for Service c,� S — 'Z�0- —316 0 1.3 Zoning Information: Zarin District Pr osed Use Signature Telephone 1.4 Property Dimensions: Lot Areas 3y^�1 Frontage ft 1.6 BUILDING SETBACKS ft Name Print Address for Service: Si nature Telephone Front Yard 4'A — Side Yard 1' 4, — Rear Yard Required Provide Required Provided R red Provided License Number l�ays�y. 3)5 Address y �, �1 � Signature Telephone 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service c,� S — 'Z�0- —316 0 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Si nature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0, Licensed Construption Supervisor: License Number l�ays�y. 3)5 Address y �, �1 � Signature Telephone 3�Zf��O2 Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ 16-7-z 1 �Q Company Name Registration Number Address Expiration Date Sr nature Telephone SECTION 4 - WORKERS COMPENSATION (NLG.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 ....... 0 SECTION 5 Description of Proposed Work(check all applicable) New Construction 0 Existing Building K Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify n.eet.r -- Brief Description of Proposed `Work: `` p ^� �,P�e1w. �- �4 � �G� �Kr�.tiUJ0.'1�c�n ���� 1.1.1• L.J�c'h:� 1 � SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant g OICIALiUSE ONLY 1. Building \\4-• eO (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (8) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 .�v 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 1, ,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 Si attire of Owner/A ent Date Jill ImMalaml NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s•r 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSION'S OF POSTS DFAENSIONS 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 t r--- - - 152 - �=- 41 24 /-24 -f- 24 39 35-- -88 150 - All dimensions & size designationsI This is an original design and must given are subject to verification on i not be released or copied unless job site and adjustment to fit job applicable fee has been paid or job conditions. I order placed. 78 Design: 10/15/00 Dw�g no. Scale : 3/8 " = 1' I Date : 06/13/01 Designer Note: This drawing is an artistic interpretation of the general appearance of the floor plan. It is not meant to be an exact rendition. Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM NORTH O¢�s�mo C+� 6 ~ 1' •yam• I• !a O 9 COC [MwKA 1 C7 ACiIUs�t� In accordance with the provisions of MGL c 40 s 54, and.a condition of Building permit• # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, s150a. The debris will be disposed of in /at: Facility location i :✓ Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. .J/ize °�ar,�no.i�ueal� o�'✓�vacluc t BOARD OF BUILDING REGULATIONS License: ;CONSTRUCTION SUPERVISOR Number,ES 033217 Birthdate: 03/26/1953 _. xpires: 03/26/2002 Tr. no: 19177 Restricted To. AU = " FRANCIS A HEBE PO BOX 379 �•iµ�%�t ,W BOXFORD; MA 01885 Administrator -y HONE IMPROVEMENT CONTRACTOR-t.� Registration: 107916 Expiration:. 8/10/02 Type: Private Corporatio r FRANCIS HE'D -CONSTRUCTION' Francis Hebb t ADMINISTRATOR PO Box 379/ 70 take Shore :;B4Ozford NA 01885 06/19/01 TUE 11:30 FAX 9785322217 ACOWL CERTIFICATE OF LIABILITY INSURANCE B. -K. McCarthy Ins. Agcy. Inc. 100 Cummings Center Sui Beverly to# -L MA 0191- 6105 978 927-8899 INSURED — -- _ Hebb Construction Inc, 70 Lakeshore Road P.O. Box 379 West Boxford, MA 01885 Z002 DATE (MM/DD/YY) G6/ !9/01 ONLY AND CONFERS,bUhU NO RIGHTS UPONR HE OF CERTIFACATE BOLDER. mis CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER/k TheTravelers Insur _n. -.. Co __.._..__._.._ ----------.___ a..ce �m an - INSURER 8: __ .._ .-. _..---�...._..... INSURER C: INSURERD -._ ....... __ ..__..__.._._. _._ .- ...- _ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWfTHSTANDWC, ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXri USIONS AND CON POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS �'iTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR F i ICC _...—.. ..—..—..—., J1 Rvi3j OF JU4H.� TR ( TYPE OF INSURANCE I POLICYNUtNBER POLICYEFFEGTlVL- POLICY EXPIRATiON"-_...._—...__.. .— A I GENERAL LIABILITY DATE M/DDDATE M DDiY I. _ _ _UM1T5 _ . _...__..... ..._.. -- II66Q821C�$ObTI.0 12/16/00 X12/16/01 IEACHOCCURAENCE $ X ICOMMEACIALGENERAI LIABILITY I -. -.- .... _. 1., .0.,,-.O n 0 I ��I CLAIMS MADE�XJ OCCUR I I I I FIRE DAMAGE (Any one lire) i S3 O Q, 000 I X TOCP GEN'L AGGREGATE LIMIT APPLIES PER: r i PRO. I POLICY I J r7 i LOC A kA�VTOMOBILE LIABILITY ANY AUTO I ALL OWNED AUTOS i X j SCHEDULED AUTOS �n HIRED AUTOS ' `, ! NON-OWNLD AUTOS GARAGE LIABILITY i... i ANY AUTO EXCESS LIABILITY OCCUR F CLAMS MADE F 1 DEDUCTIBLE I— I RETENTION $ A I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY j OTHER -- I810970K3745IND00 ITJB881Y756900 MED EXP (Any one person) I S 5 0 0 0 . _.......... S c . -.._ L PERSONAL & AOV INJURY Oi} 0 iI GENERAL AGG9EGATE II S2 , 00 O, O_O O L PRODUCTS COMP10P AGG O O 0 O O. O _-. X2!16100"12/16/01 I I + I COMBINED SINGLE LIMIT !Ea nr:ririun) i $ BODILY ,INJURY _........—! $2 O ; 000 ... BODILY INJURY (Per accidem) iS40, 000 (PROPERTY DAMAGE (Par accident) 11S100, 000 ! AUTO ONLY -EA.ACCIDE,.N1 i$ `3TI 1ER i HA..iJ AUTO ONLY: ^ IG is EACH OCCURRENCE $ I AGGREGATE 07/28/00 107/2$/01 F�E.L�EACH RYLhII'S ! OAR !$ ACCIDENT 11$10 0, 000 ' I IE.L.OISE.ASE-EAEMPLCYEEI$100, 000 E.L. DISEASE - POLICY LIMIT i S5 0 0 0 0 0 I I I I f DESCRIPTION OF OPERATION$!LOCATIONS/VEHICLES(EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS To.•:n of North Andover Attn; Building Inspector 27 Charles Street North Andover, MA 41845 ACORD2Sti Qmr)1 of 2 #35692 SHOULD ANYOFTH E ABOVE D ESCRISE D POI -r, EES BE CANCELLED SEFCRE Tri E ERYiAA710N DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMA'LLO.—.DAYS voRiTTEw NOTICE TOTHE CERTIFICATE HO/�F RNA///MED TOTHE LEFT, FlItYFpJr FAILURE TODOSOSHALL IMPOSE NOOBLiGATtONORLTABK V�p{TyYKJNOUPONTHEfNSt T i SSS"' i', eT -� LRER,I.SAG:N;gQR AUTHORIZED LEG C? ACORD CORPORATION 1988 06/19/01 TUE 11:30 FAX 9785322217 Q003 IMPORTANT - If the certificate hoofer 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 JS 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 fora, does not —.cnstitute a contract between the issuing insurer(s), authorized representative or Producer, and the certificate holder, not does it affirmatively or negatively amend, extend or after the coverage afforded by the Pc,icies fisted Inereon. ACOR025-s(7/97)2 of 2 ##35692 m C/) 0 m CO) 0 Z CD O CL r d CD CL a� -o .o 0 o p C� c� �d CCD O .... O co CD CA 10 CD 0 ��J CO) O CO) O CO) m CD O CD CD y CD CO) O 0 CCD 0 CD CC =r O O1 = O �• N Q N C.� O CO) CL n m C) caca 0aC2 m 0, 15 d. •77 tea.. .4 CD O m CO) p CO) O :* m col ..� ®to O n O Zti•t7 o O. w .m =r ca O O V^ � m m y C� cn0 CD CD O O d CA : N W ca i. '�-Got CD O O ... CD 0 �o cn Z N CD CD cn tz � O �• ImCD CD •�: CD CD =s: Ommi 0 9 cn rD ('D cn + 0 O 7N% .�V 171 O ?r ai n,' Y'fi ��� D c =r > Crf n C)z �? w O aha v 0 0 ='- a" z O qq G p CL o. 0t" c� O �s CL n s cn rD ('D cn + 0 w El d 171 O ?r z O G� w � w c z O o0a Crf n C)z �? w O aha ,� C7 pt � O m 0 ='- a" z O qq G p CL o. 0t" c� O c .d CL n O d O MH W 19-57 ) /�q? 6 Date .... A .............. .. -- X, TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... ............ ....................... .. . . ......... .. . .. has permission to perform . 4.L1 ....... ............... . .... .... ............. ... wiring in the building of ...... r041 A �?v!.!� � ........................... at ...... .......... ...... �[ ................. North Andover, Mass. 41 Fee..U.,d".. Lic.NoA?/'�-/ ...... ............. ........ .... >- i 6 n , ....................... ELEcTRiCAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 7I1EC(1M1t10NWF.AL7710FATAS3'4MU.S'ETIS Office Use only DLPARTAfi7yT0FPUBUC&4FE7Y Permit No. FORWARD OFF WEPREVEM0NREGM770NS527GW?12.00 Occupancy Sc Fees Checked APPLICATTONFOR-PE;AIRT TOPERFORMELE=CAL WORK ALL WORK TO 2E PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date f/ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform. the electrical work described below. PARCEL Location (Street & Number) - . 3 Owner or Tenant Owner's Address - fim- 1/ �:_F Is this permit. in conjunction with a building permit: - - Yes Purpose of Building No F-1 (Check Appropriate Box) Utility Authorization No. Existing Service Amps % , Volts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground No. of Meters Numbei of Feeders and Ampacity-------- Loc4ion and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. 4f Lighting FixturesSwimming Pool Above: Below Generators KVA — ground and No. of Receptacle Outlets No. of Oil Bumen 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 -1. Tons No. of Detection and _ No. of Disposals No. of Heat Total Total Pum Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal. El 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 kBER- - � .r nr.:r . it • •r • �� r • i • •irr^ A • ' .n� •r�.u- rr I v � . � 'r• IO • 1 I'Jr - We ktoSwto1269 ri a. , I r i 0 • may) Expua Daw ValueofIlaz6cal Wait $ %Q Z ? � Final _ 7-0 ,r -u 1l— /=I L.C-%me' / C— Lic�ee 0 9 C �7—i2 ehe/� s;ff� H(Y"TRC e OWIU2SR4SURANCEWAAEP Iamawated-atdteL=wdoesmAba ar- *Eintysignahuemthispe appywaivesthism mal)ffi (Please check one) Owner ® Agent Signature o jwner or Agent 6 et -'J AIL Tel No. erzistu-�xea>cs st>�leasr�edbylviz�n� Telephone No. PERMIT FEE���/ N2 1793 Date -S,-4 ..y TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... J7��.C3 ........... C—J.-ec�A--( ... ...................... . has permission to perform ..... �. t-cim k4t .. t ............. �,d ... (--.1 ............... S wiring in the building of ...... ...... ...................... - 14, '**"*** at ....... Z � � 9 1� S ...... I .... ............................................... .. > ....... ,/, No ;rth d r, rs. Fee ... Af -Ad. Lic. ............ . .................. . ..... ... ... ......... LECTRICAL INSPECTOR Cl� M 1-7 c? 7 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ,� ul�>i! C�ammnnur.ettl� of tt��xrl�uul:� }a2}1uttitrat of Public 06ift BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM All work to be performed in accordance with the Massachusetts Elac (PLEASE PRINT IN INK OR PE LL INFORMATION) City or Town of The udersigned applies for a permit to perform the electrical wor e8` s' cr t Location (Street & Number) 3 3 MA jh Owner or Tenant— �UyA 7- lC Owner's Address Office Use Only Permit No. Occupancy & Fee Checked 3/90 (leave blank) ELECTRICAL WORK tial de, 527 CMR 12: 0 Date o the Inspector of Wires: V. MAP o3 _ Is this permit in conjunction witha bUildin permitYes Q No ❑ (Check Appropriate Box) Purpose of Building Sl 41 Utility Authorization No. T_�;,; Existing Service Amps _h . --Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps -J Volts Overhead Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures �. Swimming Pool Above In- ❑ ❑ grnd. grnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of zones No, of Detection and No. of Ranges No, of Air Cond. Total tons Initiating Devices No. of Disposals I No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local ❑ Municipal [IOther No. of Dryers Heating Devices KW Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP dTHER INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES X NO G I have submitted valid proof of same to the Office. YES K NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. T 1/ INSURANCE X BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ (Expiration Date) Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAME ­ti/j 4%6� A SA Licensee . . LIC. NO.J ,3,3 LIC. NO. lek.) . /. Q gds. Tel. No. CO Address L%1ie,��s2�/Y!o Y�� �_1 elt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $25.60 (Signature of Owner or Agent) x-6565 0 Z T c 0 -n -n -n 3 CD cD CD cD CD -n CD 00 CD 69 69 4A '69 69 fA (A CIS C, - -- - — ------ ---- --i 0 z 0 z 0 z a 0 m m Z 0 0 0 CD ro Cw ro -4 15 u) 0 -n co 0 CD =T 0 C CD c = a > CD :3 cL F - o o 0 CD o -n 0 0 3 0 0 -n m m 0 o o m 3 -o 00 = :3 ;;: M c 0 Z T c 0 -n -n -n 3 CD cD CD cD CD -n CD 00 CD 69 69 4A '69 69 fA (A CIS C, - -- - — ------ ---- --i 0 z 0 z 0 z a 0 m m Z 0 0 0 CD 03 a m n >b> n > j > > r Z tf n> z %J C n r > M O C z >° T z n >> n n z o a x d > H°> ° m r n w O ? W n rA C O C G p �(� A = V? c: e o cj � - a C r-7111 C � � 1 C.� N 0 v C C C 'm C O C C ~ z m 7 O n O O O CCA A C r O C] C C A to t• to rn Crt n '� C7 r > O n O !i C C Z n rZ C p n O O r y A G n z rn 71 vAi cn a r r o° n n a c o c z W > ZZ N N W l� a r ✓1 `�• A 09 ° 5 W_ z © mcn C3 W z � a 177, owe so /a, t cl Ct) cl FOR —DATE-kf /—/ T I M F/.f —P.M. J m o on OF PHONED RETURNED PHONE YOUR CALL AREA CODE NU NSION A L -:)F PLEASECALL WIL . L CALL, 67 AGAK GAMETO SEE YOU WANTS TO SEE YOU sl ;2 iversal" 48003 FNOTES----- f dVC, IA -1 J 913 MA/A I DT 11N.�;f[ICTIONS 3. 1111011F.It'I'V INFORMATION VWF 1 1:11 Lflll-[�SFCTIONS 1-3 I 1'(*Iltic IN11"ITHS AIIISI-Ill,'ON (311-1-SIDEOrIMILDIM; x I IM livil NIUS1 CONVORM TO STATE FIRL III MIS INIIIS'l HE F ILIA) mm).kITROVED IIV IMILDING, INSVECT011 1) \ I 1—I'll FD 111(i Or mvi� , I , u (m Ili ICNI I I CR �N-I-iwn 1":vk(.11 s6P)(1) .11\1 r. NoKI SII t' <9 9 �o�C/STEP�� 241 9' /ANAL Fss E��"+j If I CERTIFY TO T!/E A/VOOVeR BANK ANO I7�5 T/TLE INSURER THAT TM/S PLAN DEP/CTS THE RESULTS OF A CURRENT EXAMINATION OF THE PREMISES DESCRIBED /N RECORD BOOK 65/ PASE 4133 qF THE A/o. ois7- REcls rR r of DEEDS AND THAT ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN HEREON. NOTES: I, THIS PLAN wAS NOT MADE FROM AN INSTRUMENT MORTGAGE CERTIFICATION SURVEY AND IS NOT FOR RECORDING PURPOSES. THE PLAN SHOwS THE CONDITIONS EXISTING AS SKE TCN FOR OF THE DATE SHOWN HEREON. CERT/F/GT/OM /S FOR MORTGAGE PURPOSES ONLY PROPERTY TO/t/l s� S �` %JiQTie / C /tel Tc / Cl -IMA N LINES AS SHOWN ARE APPARENT ONLY. 7-y R �- z. THE PREMISES DID CONFORM WITH LOCAL 317 3 AA ^/ S 7 /1Z 7— ZONING ORDINANCES AT TIME OF /% • CONSTRUCTION. 3. THE PREMISES DO NOT FALL WITHIN A-sCF/�E: 1 20' 7)ATE: 2 Au&, 90 FLOOD. `HAZARD ZONE 111E2 PIPEAWR&D SY: 7��. G/GU/_=•2E 2500 S8 �iFNEL S i7ATE� /STunJE 63, Arl&4 ' ,4.550C1.4TE.5 / 7 N,ILL /.4M ST AV-400VER AwO w. 2 r r. r 1 The Commonwealth of Massachusetts , Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # F7 I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity 19 1 am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address Citv: Phone #: Insurance Co. Policy # Comoanv name: TIP -a KC,S k 4e� C,mti� k Address `70 "1Lv_ g\At�.,., V_Qe Citv: (moi Kot LVA vu_ t,�Fe&� Phone#: Tl$- 3SZ-k&X?,1 Insurance Co. A, T"A ga "�-X Q" 1 c . Policv # T A a -A IrSir \-4 *zS-(A Rf 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 (V00.00) 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 pains and penalties of perjury that the information provided above is true and correct. Signature Print name Date Phone # Official use only do not write in this area to be completed by city cr town official' City or Town Permit/Licensing ❑Check if immediate response is required Contact person: Building Dept Licensing Board Fi Selectman's Office Health Department Other 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: W . V",;" S�, �e 1�c�Ie "� '. ILC (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 , 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 \ v,,\ PHONE"T'�4 100 LOCATION: Assessor's Map Number cA3 PARCEL Oce 2 SUBDIVISION LOT LOT (S) l STREET ST. NUMBER 3'3 3 *******************"***********OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm .TE Leathe, Brian To: Teichman, Thomas Subject: RE: Letter From: Teichman, Thomas [mailto:tteichman@tycoint.com] Sent: Monday, November 29, 2010 4:58 PM To: Leathe, Brian Subject: Letter Brian, We just spoke today on the phone - I am the property owner at 393 Main St. I tried to hire Donnie Fuller Construction to replace my back porch ..... He started on Monday Sept 13, 2010 and I believe you came by in the morning and told him to stop and get a permit —which turns out his "HIC registration number expired in August. I thought you told him in the morning to stop work until he obtained a permit? He continued to work till early afternoon and that is when you would not issue a permit. It was his suggestion to "rip up the contract — and return my deposit". Which I am chasing him for the remaining balance. I plan on filling a complaint with the state — against his building license and his "HIC' registration - and would appreciate a letter from you / on town paper — stating that you would not issue a permit to Donnie Fuller Construction because of an expired "HIC' registration. Could you please mail that to Tom Teichma 393 Main St. North Andover, MA. 01845 Also, if you told him to stop in the morning — could you include that? I understand I probably will not get all of my deposit back, but this would give me some satisfaction. Thanks, Tom Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: htto://www.sec.state.ma.us/ore/l)reidx.htm. Please consider the environment before printing this email. No 3',' 6 5 0 .............. Date .... ...... V� TOWN OF NORTH ANDOVER PERMIT FOR WIRING rci This certifies that ......... j .. 44 ... 4.e� ..... r C has permission to perform ....... WC "e;j,j ",/,. ....................................................................... wiring in the building of ......... 7'�. 1 rx 'r -M 0 $-A 10 (�� . ................................................................ at .......... .................................. ... . North I dover�,-]Mass. -N, VeeX.3 .. .... Lic. No. 1",3 .......... . ........ 1. �� ...................... Check # ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer uhp Crnmmunturalo gf ttggathugEttg igepartTI nt of Publir _AafktV BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. Occupancy & Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:0 (PLEASE PRINT IN INK OR TYPEALL INFORMATION) Date t/y _ G City or Town of , V6 /Al dTo the Inspecto(of Wires: The udersigned applies for a permit to perform the electrical work,described below. Location (Street & Number) a l ) 11 1 Owner or Tenant �` �) �et C Owner's Address) Is this permit in conjunction with a building permit: Purpose of Building Existing Service Amps —J Volts New Service Amps Volts Number of Feeders and Ampacity 0 Location and Nature of Proposed Electrical Work �1 Yes 2' No ❑ (Check Appropriate Box) Utility Authorization No, Overhead ❑ Undgrnd ❑ Overhead ❑ Undgrnd ❑ No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ grnd. grnd. Generators KVA I No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets 7 I No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total .4 Pumps Tons KW No. of Sounding Devices No. of Self Contained Rio. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices Local ❑ [IMunicipal Other 40. of Dryers Heating Devices KW Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES X NO ❑ I have submitted valid proof of same to the Office. YES K NO C. If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE X BOND ❑ OTHER ❑ (Please Specify) �a f�9 � � r ^�� 12 / � i // w Estimated Value of EIectrical Work $ _ � J r e /'4" f lam, VW l (E�xPiration Date) Work to Start Signed under the Penalties of perjury: FIRM NAME ­4JZW Licensee .5 /1i�. -./yR.� Inspection Date Requested: Rough Final LIC. NO. Af'33 LIC. NO. LS%3 3 Address .--)67 L,, f/U /Co 1a1YCP- /L 142,/�/✓TiO:/�� �. Z2/ L �!�'8 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) ( g Telephone No. PERMIT FEE $ c7 (Signature of Owner or Agent) x-6585