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HomeMy WebLinkAboutMiscellaneous - 40 CAMPBELL ROAD 4/30/2018 40 CAMPBELL ROAD U / - - 210/106.6-0009-0000.0 Date Z- I?,►. . 9447 TOWN OF NORTH ANDOVER PERMIT.FOR PLUMBING sS�1CNU'S� This certifies that . . .:. . . ... . ' has permission to perform . . . . . .�. 'p ^ f plumbingin a buildin sof . . . . _ � � at . .'Tu. . . 0..,m. ,p.J�. �. . . !� bort, • •ndover, Mass. Fee. . . . �. .Lie. No 4k? . . �� .. . . . . . . PLUMBING IhISPECTOR Check # �� 1 ' / Date cot 1.��.�.. . .. . ,aORTIy TOWN OF NORTH ANDOVER FO i A • - PERMIT FOR GAS INSTALLATION , y SACMUSEtt . This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . .�.o. !:.. . . . . . . . in the buildings of . .�f' . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . .� � . . ., North Andover, Mass. Fee:- Q. . . . Lic. N45.b3�. . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check# ' , 8193 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY FYI U Ga:�..r�LUU�"' _ MA DATE 'tom_/ PERMIT# �I3 JOBSITE ADDRESS OWNER'S NAME GOWNER ADDRESS vvt TES(� FAX� TYPE OR OCCUPANCY TYPE COMMERCIALE]__I EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:[l RENOVATION:0 REPLACEMENT:FIR-" PLANS SUBMITTED: YES�_I NO Q APPLIANCES 7 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE ,J DIRECT VENT HEATER f I+_ _�== _ :..:_ DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE L - 1 ._z .__( I --- _I ____.. ._._._. [ _J =_1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN - POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT I—`- IL J TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _.. OTHER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES JUb 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY © BOND L__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 [i AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are tru and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co an wit all P ine rovf the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE# SIGNATURE MP 0 MGF JP [ JGF ( LPGI E] CORPORATION[' # , 3 �j/ PARTNERSHIP ]�f# 'LLC[---J# � COMPANY NAME:,�X- -(Y ADDRESS /JU O k S'S Y CITY .-_ I STATE DL ! S 7_ �_� _.,U_ ;Lv U . _1� v-L-�-- TEL FAX SL�"�'zL 'e CER ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES .AM"- - '). Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES t-4", The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): _� �Piy�i�„� .� zpl L� Address: 16 o 6d �" y City/State/Zip: y ti Phone#: Areyouan employer?Check the appropriate box: Type of project(required): 1.El 1 am a employer with 1i 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ? ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *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 aie doing all work and then hire outside contractors must submit anew 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. a Insurance Company Name: —),L Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: L(V City/State/Zip: _,_19 y. �+✓� u�-`� !� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I I do hereby cer u d r the pains and p nalties perjury that the information provided above is true and correct. Simature: Date: Phone#: 7 i 7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: f ST . X11. 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 numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFB Revised 5-26-05 Fax#617-727-774.9 wwv�axxass.go�ldia f J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITYU �c�v-'t� MA DATE _� �- PERMIT# JOBSITE ADDRESS v ` OWNER'S NAME ,p/�- POWNER ADDRESS! -11 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Ell RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION: REPLACEMENT:Er PLANS SUBMITTED: YES EI NDE] FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 1 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN ____f f _-_._.___ INTERCEPTOR(INTERIOR) __ k ( f _..__.-__.i KITCHEN SINK LAVATORY ._.I ----..._.I __....---� _.__._.J _-_.__.J _._____i __._.._.._.f �. f __---( ___..._.J _--[ --_-_.__.1 _ I ► ___-._-__1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL _ �1 ........___! 1 ..__...__-I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING _ _ [ i _( _.._._._[ ! [ _..... i OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[ NO M1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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: OWNER Q AGENT M SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true an accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be i o Iia with all rtine provisio f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMEa LICENSE# _fD ,3 � I IGNATURE MP Md JP 0 CORPORATION[9# PARTNERSHIP S# LLC COMPANY NAME - ADDRESS �p CITY U, „✓c( 1 L SII _� '�� ���-- STATE DYL ✓�1- ZIP Q �� � TEL FAX M ft4 -0 qE CELT 7...___�--OIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES t'`tes._.No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES O f The Commonwealth of Massachusetts Department ofIndustritrl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Lezibly Name,(Business/Organization/Individual): Address: k b y City/State/Zip:1/d4Phone#: 7/ t49 p z� Are you an employer?Check the appropriate box: Type of project(required): 1.[TI am a employer with 0'2— 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[J Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.[i Other !Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isrovidin workers'compensation insuranceformy employees. Below isthepolicy andJob site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: !) 111-214 01 - Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby er he pains and pen I of jury that the information provided above is true and correct. Si ature: c Date: l Z v Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need 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 of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 Qxt 406 or-1-877�,MASSAFE Revised 5-26-05 Fax#617727-7749 v�ww.zxxass,go�fdaa ed PEa31IT No. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE MAP +40./ l —/Or LOT NO. O 2 RECORD OF OWNERSHIP (DATE BOOK :PAGE ZONE /�` , SJB DIV. LOT NO. I 1 _. L CATION PURPOSE OF BUILDING Iftf LI OWN R'S NAME ��N � NO. OF STORIES SIZE Ac - - OWNER'S ADDRESS ��Q J� BASEMENT OR SLAB ARCHITECT'S NAME SIZE dF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME I ,p /� ` ♦I SPAN DISTANCE TO NEAREST R'.i1LDING l „{ DIMENSIONS OF SILLS DISTANCE FROM STREET - POSTS DISTANCE FROM LOT LINES — SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS SUILDIyG NEW SIZE OF FOOTING X 18 BUILDING ADDITION MATERIAL OF CHIMNEY 19 BUILDING ALTER.&TION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE ' INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH BIDES EST. BLDG. COST - EST. BLDG. COST PER SQ. FT. PAGE 1 FILL OUT SECTIONS I - 7 ,�(y PAG[ 2 FILL OUT SECTIONS 1 - 12 IST. BLDG. COST PER ROOM_ SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING n , ' 4 APPROVED BY S ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BUILDING INBPZCTOI SIGNAT OF OWNL.y AUTRIZED AGgNT p. E , OWNER TEL/ PERMIT GR&NTAD CONTR.TEL/ CO 2^2��-� ( , 19 CONTR.LIC./ Q ��r0 `- " .. , H.I.C./ ZZ / ! `T BUILDING` RECORD 1 OCCUPANCY 12 SINGLE FAMILY I I S.ORt S THIS SEC ION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY' offlCEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- .. APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION ES INTERIOR FINISH ` CONCRETE CONCRETE BI K. PINE BRICK OR STONE HARDW 0 PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT I AREA•FULL FIN. B'M'I' AREA _ V. %. FIN. ATIIC:AREA _ N_O am I FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS S. CLAPBOARDS DROP SIDING CONCRETE W000 SHINGLES EARTH ASPHALT SIDING HARD"/D ASBESTOS SIDING _ COMMi N _ VERT. SIDING ASPH. IILE _ STUCCO ON MASONRY _ STUCCO ON FRAME ATTIC SIRS. 6 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR ADEQUATE I-1 NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM 17 FIX.1 FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR IILE DADO 8 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G . . UNIT HEATERS . .. .. GAS 7 NO. Of ROOMS OIL B'M'T 2nd _ ELECTRIC til I ].d I NO HEATING ' 1„d b i ILI" r � IN l v Q r►O R T/y j own of 4 over _ * + T A_CO CHICNEWIC K dover, Mass., 19 '9s 0q�1 E DP`y �G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR- THIS CERTIFIES THAT.........1.4......:................ .......... ............ "' " "" "" "": Foundation .. i has permission to erect......va . . ...... . .. buildings on ..... ?� .... .,. ........... ...................... Rough to be occupied as............. .. �.. Chimney ................................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. l*Iql.;;0 1 _ (_1 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 90 04, Rough PERMIT EXPIRES IN 6 MONTH Final ELECTRICAL INSPECTOR UNLESS CONSTRU N STARY'S/ X. Rough ­�::`� :j` : :.. .... _" ..... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building-- GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner /✓2/-G 6 Street No. r Smoke Det. 'ERIfIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS., PAGE 1 MAP SIO i Q LOT NO ZI o2 RECORD OF OWNERSHIP DATE 11390K ;PAGE- 9 ZOONNn SUB DIV. LOT NO. I _ �-- LOCATION / PURPOSE OF BUI DING ^ OWNER'S NAME I 4 C NO. OF. STORIES „� SIZ OWNER'S ADDRESS C' BASEMENT OR SLAB � ARCHITECT'S NAME a SIZE OF FLOOR TIMBERS 18T� 2ND 3RD BUILDER'S NAME !v /-,- - .I/`r A/{ I/ U DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES /\. REAR GIRDERS AREA OF LOT 5/0 r , FRONTAGE HEIGHT OF FOUNDATION - THICKNESS IS BUILDING NEW N O SIZE OF FOOTING ,! X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION , /v IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE • IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH BIDES LAND COST EST- BLDG. COST " PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER Sp. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM ELECTRIC METEP6 MUST BE ON OUTSIDE OF BUILDING. SEPTIC PERMIT NO. 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR " DATE FILED , SIG ' OR eu"Diwa INSPtCTOR . na,�nveu LHp AGENT FEE _71� ^r- OWNER TEL# PERMIT GRANTED CONTR.TEL X 1>i 22 CONTR.LIC./ � d' /6 2 H.I.C./ �r ,� OCCUPANCY BUILDING RECORD 1 12 IN-LE fAMILV SiOk1ES MULTI. FAMILY OFFICES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM APARTMENTS I LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- CONSTRUCTION RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 2 FOUNDATION 8 INTERIOR FINISH , CONCRETE 3 1 2 '3 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT I AREA FVEL FIN. BMT AREA _ -��— FIN. ATTIC AREA _ NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDv�p h ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME — B N Y ATTIC STRS. d FLOOR BRICK ON FRAME I— CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR R ADEQUATE I-1 NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) _ GAMBREL MANSARD TOIIET RM. 12 FIX.1 FLAT SHED WATER CIOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR d GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING i l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS.d COLS. STEAM STEEL BMS. d COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GO� 1 B'M'T12nd _ ELECTRIC Lt i 3.d NO HEATING i , //. (�rriixoiriiNrrll/r ��:_. l�ruuc%u�r<I�� — 'HOME IMPROVEMENT CONTRACTOR, Registration DEPARTMENT OF PUBLIC SAFETY '' `-_ _ TYPe - INDIVIDUAL rONIANUCTION SUPERVISOR IICFNSE kxplratlun 01/0J/yu =rte;- NuNber: Expires: Birthdate: CS 021621 12/11/1991 12/11/1950 MORIN CONSTRUCTION CORP Restricted To: 00 _ JEAN N. MORIN JEAN N MORIN `Z/,--Q,��REST ST 895 FOREST ST ADMINISTRATOR NORTH ANDOVER MA NO ANDOVER, MA 01815 / Y :: :::::i:::::: .....: :::::::::::....:::'_::: ::::;:';:;::::i::::::;::::::; :;ii::i;::::"::::<:::; ;:i::i;::::;:::: i::is::::::::: ........ DATE(MM/DD/YY) ...........� TFiTF IBLIY` ' 07/01/9 ,CER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATICYN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR A & K FOWLER INSURANCE AGENCY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I 200 PARK ST. COMPANIES AFFORDING COVERAGE NORTH READING, MA 01864 COMPANY (508) 664-0366 FAX: 664-2209 A WAUSAU INSURANCE INSURED COMPANY JEAN MORIN B JEAN MORIN CONSTRUCTION COMPANY 895 FORREST ST C NORTH ANDOVER, MA 01845 COMPANY D CDVERAGES »:.. °' ..... _.. _. _. . THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/Y`,j DATE(MM/DD/YY) _GE ERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ CLAIMS MADE []OCCUR PERSONAL&ADV INJURY $ OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED EXP(Any one person) $ AUTOMOBILE LIABILITY -- COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ r HIRED AUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ s T — WC STATU- OTH- udGRY.ER..COMPGNSA.10N AI.D EMPLOYERS'LIABILITY EL EACH ACCIDENT $100, 000 A THE PROPRIETOR/ INCL 1517-00-100872 12/14/96 12/14/97 EL DISEASE-POLICY LIMIT s500, 000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $1 0 0, 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS INSURANCE VERIFICATION FOR TOWN OF NORTH ANDOVER BUILDING INSPECTOR C FiTI I A N4�17 1 ':>:; N ......1►1'TlRlsf.... .......... .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE KATHERINE PARKER EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 40 CAMPBELL ROAD 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, NORTH ANDOVER, MA 01845 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. .................................................................................................AUTHORIZE:::::�EE.S..E..N..T..A..T....I..V....E..:.� ::. ............1......_........... ... . _................................... ................ ACQRI : ; 5{ll � .. �.. . -- I - -- - - -. 6X6 I i l , T I 1 T I t I I J I .✓ s..r )) fF I - I �4ORT Town of _ - Andover 0 No .,3o97 4* °0LAKE iy , dover, Mass., 19 9 COCM ICMEWICK 1• •�� Oq4 T E D E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............................................. .... ....'7`1 .��2�( ...........l..�I�.CF-/�� .,................................ Foundation has permission to.erect.... -, !lZ-,....... buildings on .......e�..<).........C...�C?-��lJ.�.�../..........k..0.,............. Rough t0b8 OCCUpled as............................................ .� !`SC. . .............. f ; ....................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ................................. .. ..... .. .. .......................... .......................... Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing, or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Date.. � Z- JJ . oG..... NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION O ...... jA f 9 SSACHUSEt i This certifies that .�_. . . : �' . . .. . ..��`:. . . . . `. . % . . • • • • has permission for gas installation `.!... . .`.'. . . . . . . . . . . . . . . . . . in the buildings of . . . . :! '. . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee ?. . . . . . Lic. No.. ... ./.a>. . . . . . . . GAS INSPE �H� WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type)I - fD U%p 1) , Mass. Date_ /j- -� 199 Permit #Building Location - �Y�?,d/✓2�/ �. Owner's Name ¢� "iL., Type of Occupancy r ' New j Renovation ❑ Replacement ❑ Plans Submitt Yes[] No ❑ N GN a W N N N V Id z Q N <A cc N x Q N = �z. W J N W 0 V m N S Jl z O u ~ a Z 0 }" w a m N H a ¢ O d h °c N W d = Z �-. sn a d N cc W z V W N W a cc O' a W ►- r x C7 F = J f- X F• W W d O > u rW- V J W z a W Q r N m z O 2 W O a W > W z, a ¢ a a to x oC .x O d 7C U. a 3 C d V Y p a Mme- O SUB—BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR <; Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Ad&ess 55 MARSTON STREET �O Corporation 1862 LAWRENCE, MA 01840 — ❑ Partnership Buslness Telephone 508-687--1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have acu renntt liability insurNo ance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked ye, please Indicate the type coverage by checking the appropriate box. 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 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 certify that all of the details and information I have submitted(or entered)in abo pplication are true and accu�te to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. U T e of Ucense: Plumber Signature of Ucensed Plumber or Gas Title Gasfitter City/Town Master License Number 8697 Journeyman APPFiOONED FICE SE ONLY i• BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO;DO GASFITTING NAME & TYPE OF BUILDING LOCATION OF BUILDING ire PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE X19 GAS INSPECTOR TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD A.9102- OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) Rd. /do . 0-,nd LU \"I E OF PUMPING: 9 --t%-0'2-- QUANTITY PUMPED /0CQG i:�.�l UUL. NO YES SEPTIC TANK: NO YES ATURE OF SERVICE: ROUTINE EMERGENCY U11.>FRV.\TIONS: GOOD CONDITION FULL TO COYER HEAVY GREASE BAFFLES IN PLACE ROOTS /LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER 04HER (EXPLAIN) � UMMENTS: UN"IFN I'S' `I'IZANSFEIZIZED TO: i ' 4 f �('C)ti4'N Uf• NUK"I�t-t ;�h'Ch..! � :. ' i:�'1/ - � ,.4 SY8'Tp-N-1 PIJMPINU RFC�C�kl... i Live - �Y51'6M ct ADDRESS S TF f ey, 04- rvK� GN nRy lep-: vur(N GOOD CO ) Y 099 ii r x K0QT3 BXCU$IVg 304,QS �.. f't.00DBD D KUNBA(, , "OL mc'�►�Yo e' ONER EXPLAIN �'VMMrrNT�. /wG ;:��: , ,, • d �IR•IT� A1�IDOVER:"MASSACHU c RECEIVED I ' 8 m Rec SETT � �'�':� '�`J)�J1� �,°{�`'RIJi 'r• � ,l;>�;'�,,r��h/✓� r� ,,,,., . � ,' nll\�lrlY�,�.. J.Ii.YJ•`bl i('I 4i.,,' I,l• .��„',C;�/?1'. ha# provldad 1h1� lolm to neo 'y ;oco! Boa/ oa ►' /r.l Ilod (o the loc+l 8ca1<: cr noalln Poi noa '�o _ . o/ oleo/ �p�loJ'A�h� 0 l�o2 l A, Faclllty Inforr ,a,a (Don TOWN OF NORTH ANDOVER 4 '^�` • HEALTH DEPARTMENT aP VM nm C17/To,rn r .r,% �{ SSI�'•d�i.,�r'2',�i SyJl9fit Own$r;Pf ..., Ir 1 ►1r (114VfPrrnl rpm bcaVcn) . T� opnon� n,mo�l "pumping Rogord 1.• Oa;e o! P�mp�n0: oi:P / ? �':ar"�, r.- :sc --�L�'�_� 3, Typo 91 . 1'i ... � C999p001 9 S9pl!C Tens '� r Q%O har (describa�: Emvonl Toa FIIIo(,Penr? Q' Yo9 Q no ,r ;1•,.;, ;T11`� .t\, �1��,. YBg 87 I; c aanao? r7 — ;. `; ..•, �;:., :;)', �„I •, . '/ .._. Yes m,,.� — 7. •6,' Sy P�'mp �1 ed 8y' ' a,�� `J11!•(r'�'kl. I (`. 1.4'1 n .'If�.l%i'J,Ii ' V0111 ,,r .r/,;I.�.'',�i,l��i' ��� ��' •��'',�' ..�� ///� '}/•(///�)'(y/y/./� ///y/� TSP, on.where'cor�!antJ'.yrere p •I..:,: dl9 oseo: r,'7 , `�;.';,:/.,�,;�'•�!, St�nP0.uP olhJv:�(y�.,;y,<.,. ,.� .. 7`' 9 F.�waiar/epproYa�sJlblorm�.r.mal�9�ecl � i Commonwealth of Massachusetts W City/Town of No.Andover a System Pumping Record Form 4 4M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. Syste Locatio forms on the computer,use 9 Wa ' only the tab key Address to move your No.Andover Ma 01886 cursor-do not usthe return City/Town State Zip Code key. 2. System Owne tab Name Address(if different from location) —C r FEB ��12 City/Town State TOWN2W,94 PTH ANDOVER HEALTH DEPARTMENT Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. S stem P mped By: nnnn Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: ft*rt'sk-trgatrfient Plant, 20 So. Mill Bradford, Ma 01835 Date o eceiving aci , Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1