The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 41 FOXHILL ROAD 4/30/2018 - 41 F -0ROAD 210/037.0C-003037-0000.0 .. .. Date.� }432 "ORT: TOWN OF NORTH ANDOVER TRW PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . . p`� !�I . . LA(-e-�Vlb. . . . . . . ?l 1 . . has permission to performPAk�M �� . . . plumbIn2 in the buildings of . .. . . . . . . . . .j� . . Al 22 XV'j.\ . . . .. . .... . 77N , Aoat . . N ver, Mass. .l.I ry Fee � .Lic. No. . . . . . . . . . . PLUMBING SPECTOR Check # !C\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _I MA DATE 1_b=y I PERMIT# JOBSITE ADDRESS ��DSC�ii� v OWNER'S NAMES �aE POWNER ADDRESS TEL FAX F i TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES® NOD FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM __..._..-_I 1 ___..__I ! _I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ( .............! 1 : DISHWASHER DRINKING FOUNTAIN _.J ____.._..1[.-- -j ---_.-__! f ( _..__._i .___._._1 ____._._� j!____._..I FOOD DISPOSER ! ..__._-_! ........_.__I f I _jI FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ..........- -1. 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK ._..__ P TOILET __......._ I I_ _- _� _._._.E URINAL ._-____,f _.-___I -----J ------__.. ..... WASHING MACHINE CONNECTION WATER HEATER ALL TYPES. WATER PIPING _. _( _.__.._ OTHER .__._...._..i ! �! —_l INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D__I BOND 0 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER —i AGENT J0_I Q hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best o my knowledge and that all plumbing work and installations performed under the permit issued for this application willa in compliance with all Pertin pr ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME M_�t,� J .[!1 €LICENSE# �3� ( SIGNATOR MP JP CORPORATION 01#� P (PARTNERSHIP I# __ _- i LLC I COMPANY NAME �y L [ ADDRESS q 3 CITY�—��--Q �r -� ZIP — - ---- '--$' ----....__._......_...._I STATE Q�Q TEL C -- i FAX I . LL I EMAIL i ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes- Ao THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ _ Z�1214�1 FEE: $ PERMIT# PLAN REVIEW NOTES ,J The Commonwealth of Massachusetts Department of frtdustrial Accidents Office ofInvestigations 600 Washington Street Boston, AM 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A rm Iicant Infoation • Please Print Legibly ' Name(Business/Organization/lndividual): t4CU4 cte— Address: City/Sfate/Zi - Phone k e 02 l � 3� 3�-�' �G� A6you an employer?Check a appropriate boa: 1. I am a em to er with 4. Type of project(required): P Y ❑ I am a general contractor and I _ en}ployees(full and/or part-time).' have hired the sub-contractors 6' ❑New construction 2. am a sole proprietor or partner- listed on the attached sheet. [7. ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers' comp.insurance. 8' ❑Demolition [No workers'comp.insurance 5. ❑ We are a corporation and its 9' []Building addition 3.Erequired.) officershave exercised their 10.❑Electrical repairs or additions l.I am a homeowner doing all work right of exemption per MGL 11.[]'dumbing repairs or additions myself. [No workers'comp, C. 152,§1(4),and we have no insurance required.)t employees. [No workers' 12.E]Roof repairs COMP.insurance required.) 13.❑Other . Y SIPPhcant thst checks box ti rsust also ji o t the se Pt �,,., eirozz _ T Homeowners who submit this affidavit indicating they are doing all work and then hireutside 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 is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/Sta Attach a copy of the workers'compensation policy declaration page(showing he policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500a d and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine n e to tions 0 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. Ido eby certify under the pins and Iti f perju'Y that the information provided above is true and correct: Sienature: Date.: • Phone#: Dfficial use only. Do not write in this area, to be completed by city or town official I City or Town: ' - Issuing Authority(circle one): Permit/License# I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing,Other b Inspector 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 coinpliance 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 i 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),addresses)and phone number(s)along with their cerdficate(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 LL'C 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 LJ et_T^::t fl o..to�T that the 1 li ou f the r License i being r � tF 4 ' � t f �•rte_ te_• o e,-e�'sIV t�p�ta.t_ Fup ieCau ffrrt:: pE�d��`b'C1_1<. _ i•b g^.P.q.1�S.,.d,nC�a t9r�1 F�TL�T.�,.Or 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. 617-72.7-49900 ext 406 or 1-8.77 MASSAEE Fax 4 6.17-727-7749 Revised 5-26-05 ��c XUIX7 T"WIC, rr-111T, Date. .at ..... ... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING "I'SACHUS Thiscertifies that .............................................. ......................................... 11� has perih.ission to perform ........ ......A-i�........... wiring in te building of....... — C......... . . ................. . . at.... ....... .North over,Ips. VY Fee.,3—�..,.......... Lic. Check # ELECTRICAL PECTOR 10:869 3 No.: le- /L e Date 0 �' r -4 f NORTIi 3=�_t��t�_''�a��o� TOWN OF NORTH ANDOVER ° p BUILDING DEPARTM ,NT 'VSA US $ f y Building Inspector ' k �f '7 Jun 03 12 02:02p Microsoft 9789753726 p.2 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. J® Occupancy and Fee Checked 130ARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 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 (PLF-4SE PRINT I,VIArK OR 1TPE.4 LI FOR,VL4TIOA9 Date: City or Town of: _ , To the Inspector of W res: By.this application the undersigned gives notice of his or her intention,to To the electrical work described below. Location (Street&Number) Owner or Tenant 5Cw! He n>7 C c�YL Telephone No. Owner's Address Ste,ry-L C Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 1, t Amps 1,77y!r V4 O% Overhead❑ Undgrd No.of Meters New Service Amps ( Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ` . �,� lee- Completion ee-Com letion o the ollowin lable be waived b v the Inspector of Wires. No.of Recessed Fixtures Na of Ceil.-Susp.(Paddle)Fans No.of -Total Transformers KVA No.of lighting Outlets Na of Hot Tubs Generators KVA No.of lighting Fixtures Swimming Pool Above ❑ In- 1❑ o.o Emergency Lighting pr d. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones No.of Switches _2. No.of Cas Burners No.of Detection and InitiatingTotaDevices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 'Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Nesting KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: Na of Devices or Equivalent No.o Heaters KW ater o. Signs Ballasts Data Wiring: No.of Devices or E uivalent ;Y No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional derail ifdesired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE JR1- BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 6 /a Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury,that the information on this application is true and complete. n IF]RM NAM E: .f�GsJ� �� lrcfi« LIC.NO.: Licensee:��, �i{� /�.�wr Signature LIC.NO.: (lFapplica6le, enter "exempt" he license bet lin-) �'� a� 6�,�j Address: �✓ ) � � `� Bus.TeI.tIYo.: Alt.Tel.Ntoo� OWNER'S INSURANCE W VER: I am aware that the Licensee does not have the liability insurance age normally required by law. By my signature below, I hereby waive this requirement. ]am the(check one)EJ owner ❑ o ae Owner/Agent Signature Telephone No. PERVIT FEE. $ i v� �i � 1 d � �-� -� w, 'y:�:k� 'i!"."•t .:sM?�'�'fia';"„ _ •-� Date...... ......�... t HORTp 4 TOWN OF NORTH ANDOVER F � P PERMIT FOR WIRING U This certifies that has permission to perform wiring in the building of............... ?I ! l�t ./'`�' ............................ at.. �..r ,. �f [ �! 5�.., X6. .........................North Andover,Mass. Fee...L9 Lic.N&9/2.0 c--�!.. ff� 1 -A . ELECTRICAL INSPECTO Check # 7367 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked r [Rev: 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the.Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 419!2007 9:36 am City or Town of. Al. Andover To the Inspector of Wires.- By ires:By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 41 Foxhill Road Owner or Tenant Joe Henningsen Telephone No. (978)394-6568 Owner's Address same Zip Code: 01845 Is this permit in conjunction with a building permit? Yes No ✓ (Check Appropriate Box) Purpose of Building Single Family Utility Authorization No. . Existing Service. 200 Amps 120 /240 Volts Overhead ✓] Undgrd E] No.of Meters 1 New Service Amps / Volts Overhead E Undgrd No. of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: basement finish-new receptacles, lights,switches. replace main electrical and sub-panel in home.Wiring for new heating and air conditioning equipment. Completion of the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Fixtures 0 No.of Ceil.-Susp.(Paddle)Fans 0 No.of Total Transformers KVA No.of Lighting Outlets 0 No.of Hot Tubs 0 Generators 0 KVA No.of Lighting Fixtures 0 Swimming Pool Above In o.o mergency Lighting . 0 rnd. 0 rnd. Battery Units No.of.Receptacle Outlets 0 No.of Oil Burners 0 FIRE ALARMS No. of Zones 0: No.of Switches 0 No.of Gas Burners No. of Detection and 0 Initiatin Devices. No.of Ranges 0 No.of Air Cond. 2 Tonal 4 No.of Alerting Devices 0 No.of Waste Disposers p Heat Pump I Number ITons _ KW No.of Self-Contained Totals:Totals: " -------- Detection/AlertingDevices No.of Dishwashers 0 S ace/Area Heating^KW Local Municipal p Connection Other No.of Dryers 0 Heating Appliances 0 ICS' Security Systems: No.of Devices or E uivalent 0 No.of Water No.of No. of. Data Wirin Heaters 1 KW Signs . 0 Ballasts 0 No.of Devices or Equivalent 0 i Wi Wiring: No.Hydromassage Bathtubs 0 No.of Motors 0 Total HP Telecommunicationsg' 13 No.of Devices or E uivalent OTHER: — — - Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE '✓ BONDE] OTHER (Specify:) GENERAL LIABILITY 07/15/2007 (Expiration Date) Estimated Value of Electrical Work: $3,800.00 (when required by municipal policy.) Work to Start: 04/1112007 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and,complete. FIRM NAME: S.A.Caron Co.,Inc./DBA Caron Electric / LIC.NO.: #A17039 Licensee: Scott A.Caron Signature LIC.NO.: #A17039 (Ifapplicable, enter"exempt"in the license number line) -6900 Address: 11A Cypress Drive, Burlington MA 01803-4907 Alt. Tel.No.: (781)389-0700 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability.insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)J owner J owner's a ent. Owner/Agent SignatureTelephone No. PERMIT FEE: $ 190.00 i l - I ,n.✓.F Y'+�:t r y: ,. ��q,.ge�,. .r .�3""kf8r,.,N�fi'n � s. Yi. .. F., 'gid.^u A'.... � ::t ei.l �0�ti n : t q Date///a,.,?. . y: jcIAtiao TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 1SSACNUSE� This certifies that ,/'� lAf?!.Ce. . . .� .f?�. . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . >!l?p?.t S.c, L^. . . . . . . . . . . . . . . at . . . . . . . . . . . . . .. North Andover, Mass. �. . . kFee. 30 . . . .Lic. No../3/0.4. . . . . . . . . 4.4 �� . 'PLUMBING INSPECTOR Check # 7,569 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO ®O PLUMBING eow (Print or Type) Mass. ®ate ��— � 2007 Permit# � J Building Location C p' p , Owner's Name GXVL-�;l Owner's Tel# Type of Occu enc Yp p Y e, New® Renovation ® Replacement Plan Submitted: Yes No ,,✓ '. Z cnz Y� a F- r U11.1 W z w w W z U) Q X g - ~ Z o z rn a w U5 w N (n = w cn x a LL Z a Z x v Z XLIJo M w X I— cn z ° U) 0 9 a � O LL LU u- Y W H V > 1-- O 2 a D U) I— z O 0 N Z z W H O U 2 SUB-BSMT BASEMENT 3 1st FLOOR ti 2nd''FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name Addario's Plumbing b Ideating LLC. Check one : Certificate Address 20 Cooper Street X Corporation 2720 Lynn, MA. 01905 Partnership Business Telephone 339-440-8100 Firm/Co. Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr. Insurance Coverage I have a current liability policy ori its substantial equivalent which meets the requirements of MGL Ch.142. Yes Ex No M If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ED 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 : OwnerEl Agent Signature of Owner or Owner's Agent I hearby 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 the permit issued for this application wi be in com liance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. i BY Type of License: Title X Plumber City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter Approved(OFFICE USE ONLY) X Master Journeyman License Number 13106 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE ,2007 PLUMBING INSPECTOR Date. .��- N2 4471 "paTM TOWN OF NORTH ANDOVER p� ,,.o ,•14'O PERMIT FOR PLUMBING ,SSACNUSf This certifies that . . . ."1! . . . -. :. : .\. . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . F plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . at . North Andover, Mass. Feej . . .Lic. No.. . . . . . . . . . . ..L :. .•. . . . . . . ./.-C. . . . . . ,•,r�� -� �L-UMBING IN�PEGTOR Check # j WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION ZPERMITDO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS 6Building Location 41 rd X 14 t(I F—d Owners Name Taw► PS k4 # Amount Type of Occupancy New rj Renovation Replacement Plans Submitted Yes No FIXTURES a t_ F E-, °' Cn o Q q ,W.1 ad19 F a � A A F aR ald tit C CAN SUBBM sc�glv>EM` � Is>c>L t I f M FLOOR 3MHDM 4]H HOM s1 BOR 6IHHfm 7M Il OR SIB EJOM (Print or type) WHITE ROCK PLCheck one: Certificate Installing Company Name ri Corp. 1609 HTG. 9 C P-e. NORTH ANDOVER, MA. 01845 Address � Partner. Business Telephone 9 78 - q 75 --4 2 Qt'f Firm/Co. Name of Licensed Plumber. ';2!d b e r+ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boat Liability insurance policy Other type of indemnity Bond ❑ Insurance Waiver. L the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent E] '• 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 PerWit Issued for this application will be in compliance with all pertinent provisions of the Mass ac efts tate PI ing Code an h of the General Laws. BY: Nignaiure ol Licenseaum er Type of Plumbing License Title 6' S 97 . City/Town License iNumoer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Lai e N° 2433 Date... f d \�� NORTp TOWN OF NORTH ANDOVER = p PERMIT FOR WIRING SSACHUS�� This certifies that ( ( � r 1 S U Inc nC has permission to perform .......I. �... C...l.��!'..... �?'''.......... ................ wiring in the building of......... P/.. /........................................... at........Z/.L . ............ ............ . orth Andov Mass. r Fee / . ......... Lic.No. /7 .Sal............. ... ........... `'� /ELECTRICALINSPECTOR Check tt WHITE: Applicant CANARY: Building Dept. PINK:Treasurer 0ilp TD1ntnunw>raid of Iffillasurf luset i Office Use Only UeparY.nrent of Public Sad=Pry Permit No. � BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 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 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFO RMATION) Date " OPP City or Town ofd y /� To the Inspector of Wires: The undersigned applies for a permit to orm the electprical work escribed below. 1� Location (Street & Number) __�x`�j / !J LY Owner or Tenant _ j�e r,PJ�� ;�✓�� __ Owner's Address Is this permit in conjunction with a building permit: f , Yes No ❑ (Check Appropriate Box) Purpose of Buildingff wl/l� �l T Utility Authorization No. Existing Service _Amps_ /__ Volts Overhead ❑ Undgrd ❑ No. of Meters �i New Service ___Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity t Location and Nature of Proposed Electrical Work _ 67 TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA A oveIn- No. of Lighting Fixtures Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Tota I No. of Detection and No. of Ranges f No. of Air Conditioners Tons • Heat Tota Tota Initiating Devices No. of Sounding Devices. No. of Disposals 7j�`LI//34)�� No. of Pumps Tons KW No. of Self Contained Detection/Sounding Devices No. of Dishwashers JOW10114 Space/Area Heating KW Municipal No. of Dryers HeatingDevices KW Local❑ Connection ❑Other No. n No. of Low Voltage 4 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 Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES L4 NO 0 ! have submitted valid proof of same to this office. YES LINO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE I BOND ❑ OTHER❑ (Please Specify) (Expiration Date) Estimatbd Value of Electrical Work $ `' ,,/ , Work to Start �/ +�-� -a Vivi/ Inspection Date Requested: Rough �� P��® Finalyy1�/ 0A Signed under the penalties of perjury: / FIRM NAME Ie e;e C �Li et' LIC. NO. Licensee Signature LIC. NO. Address "AlW,5 194- Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts .General Laws, and that my signature on this permit application waives this requirement.. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBERISSUED: —D SIGNATURE: Commissioner or of Buildings Date • d SECTION 1-IKE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: rkl Fo-Ol z z_ 12d- ,l 0 3 /00, 3-7 N /`�N y, e r � ��-. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: C Zoning District Proposed Use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 34) Zone 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIDWAUTHORIZED AGENT rn 2.1 Owner of Record Clu&(7l4,✓� �/v�-t�iV 2Ei �1 -oxr�/Ll� �� ,�/. /JNc�✓ Us. Name(Print) Address for Service: G 0 / � O � Si natu Telephone phone 2.2 Owner of Record: v Name Print Address for Service: 0 rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number mn Address Expiration Date Signature Telephone �. 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name Registration Number r Address _r Expiration Date ^ Signature Telephone Y 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.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) .❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify t ' Brief Description of Proposed Work: lc, C 4 P. eG �► SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE'ONLY Completed by permit applicant ' 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing 3 Q Building Permit fee(,a)Y tbl 4 Mechanical (HVAC)N .9 5 Fire Protection ,✓ 6 Total 1+2+3+4+5 �,a Check Number SECTION 7a OWNER AUTHORIZA ION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FORBUILDING 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 Si ature of Owner/Agent Date loll lilligilillillill'imiIg MINI NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 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 pORTI♦ Town of North Andover Building Department p 27 Charles Street North Andover MA. 01845 ��s ^�x'41 7 SACHU50 D. Robert Nicetta Building Commissioner (978) 688-9545 1978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE `L I 9 Q JOB LOCATION Number Street Address Map/lot "HOMEOWNER Ut4 M.C� j C v lyU�l,Qr�� ) 77�'��—g9o,� �1�—s63' 3-7V Name Home Phone Work Phone PRESENT MAILING ADDRESS J_ City Town State Zip Code • The current exemption for"homeowners"was extended to include owner-occupied 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 Building 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 intended 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, y 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. v HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL c ' Town of North Andover NORTH Li C. r Building Department �? 6•Oy..t4o qti c� , �O 27 Charles Street o North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 ° .... ,. pAre°� 9 p° Pa`y(y Building Demolition Affidavit �SsAcaus�� DATE OWNERS NAME&ADDRESS JAM Ff PROPERTY LOCATION �� I`n��/ �� /�• /ON V DESCRIPTION )e(/I1'4 CC 1,117CgFI/ CONTRACTORS NAME&ADDRESS DEPARTMENT SIGN-OFFS D.P.W./WATER SEWER GAS ELECTRIC TELEPHONE CABLE TAXES POLICE FIRE EXTERMINATOR DUMPSTER-ON/OFF STREET DIG SAFE NUMBER BLDG. INSPECTOR DATE RECD 1991 1171 32 50 W1236 W2736 DW36 L201 T-R j- ---J -----------� W332124 S ,3 U189024 B27SS 33 REFS/ SS. -- ---- --------------- - I W303 18R I 138 W301 -, "96137� IIS i '8RBD W273 I ----- _ --___ _r _ - _ - _ --- ----- -- 6LR36-R 3DB18 SB30D DISH. 24" BPP: i W273�' l 9 201 I it 117 - - - 3istn44�R Design : 03/18/00 D g o. I —- - ,�o. .,�.,�.h� Th;�-,;� a.,.�r,,,w.,�l�a��;,,,,..._.a.---• �maxim5m_nate 05/15!00 — - ' Location No. Date NORT„ TOWN OF NORTH ANDOVER 0 • OR A • ; : Certificate of Occupancy $ �MusE�� Building/Frame Permit Fee $ 7 ` Foundation Permit Fee $ Other Permit Fee $ (' P TOTAL $ " Check # 7`"A { Building Inspect G bZ - j= -- -—--- - bL - — tb£ Ot7 lik- _ r Ej 06 96 0 0 8 L t79 ao 0 86 9 9 bZ 0£ 0£ LZ LZ —� 8£6 �—— 9£ 8 L 0£ - 17Z / 6 0 it's Ob Ob 0 T0- - o o -- - i5 06 UL L 09 NORT1y Town ofAndover o _ . �..,.,.. No. O ,A r o dover, Mass., C I C VVIC VIE kvic k �t ADRATED P? S BOARD OF HEALTH PER IT Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ... T ................ . ....................... ... .......... �.................. ...................... Foundation has permission to ere ........... . . ................. buildings n .... .�....... .... Rough to be occupied as Chimney .......................................... ............. . ..... .... ............ provided that the Do n 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S Rough Irow ........................................................................ ...................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location No. _ A) Date Of NOoTM ,M TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ ;�s'• E CMU �h Building/Frame Permit Fee $ SAC MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y Check # I 15680 Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT REPAIR,APPLICATION TO CONSTRUCT OR DEMOLISH A ONE OR TWO FAMILY DWELLING « R�RENOVAT E, � m; $��3 'k'fp&h .�SS'.,bb9 ��•4�1�� 3 x � tY� �.� 5d „4",- �S,S��Y ari`uxntt�y� Y' S _ '«c, • �. •F ^ ^�I.'.. ,, .w,3s.'E�}e_s'P'-'•se:•S:, z(:GFr..,.: .... ,< 3 9 -. '.> S�'n-3`a, xweF, e.Y-S" ¢� BUILDING PERMIT NUMBER D DATE ISSUED: ` –C;2 A / C�_ SIGNATURE: /f�` ..� Building Commissioner/inspector of Buildings Date SECTION 1-SITE INFORMATION o 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: O Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 4- 1.7W&ter Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(P ' t)t) Address for Service: n� V Signator Telephone C 2.2 Owner of Record: I N<:me Print Address for Service: Sigmt e Telephone 9090 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 r Address Expiration Date ^ Signature Telephone !�I i 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. Si ned affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work checkaIl appHcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) W_, Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other , ❑ Specify Brief Description of Proposed Work: ale-a,<'el0/;le xJ�� olee% SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL IISE:ONLY, Completed by permit applicant v 1. Building (a) Building Permit Fee Multiplier 2 Electrical (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 AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERNHT t I, as Owner/Authorized Agent of subject property 4%. e Hereby auth ' e to act on My behal 1 all matter rel v to wor authorized by this building permit application. S i nahu f Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 3. 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 Si ature of Owmer/A ent Date <t a NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR UMBERS I ST 2ND 3KD 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 FORM U LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits Boards and Departments having jurisdiction have been obtained, Th sfrom does not relieve elieve applicant and/or landowner from compliance with an applicable Y pp cable or requirements. q ments. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT J �-ne-S C, /Yl�r► I�� PHONE 97? Z 0 LOCATION: Assessor's Map Number 3 V PARCEL n A 3 SUBDIVISION l LOT(S) STREET B� ST. NUMBER *****************************************OFFICIAL USE ONLY*********************************** REC IMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINIST TOR . DATE APPROVE5D t DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS ------------ FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED #+ COMMENTS ' PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 jm AUG_-20-99 09 :00 AM; E K SURVEY 5086880485 . P. 02 t. . MORTGAGE PCO T' PLAN EK SURVEY INC. MORTGAGOR DEED REF. ---- 0 PG. J?? ApQR �� OF PRINCIPLE BUILDING PLAN REF. 9407 11 OW& Rd, DATE OF INSPECTIQN vo ' f cc, NOTES fib mortgay• Insp.etlon .vN Pt�tid �?�� I FURTHER SATE l 1�{AT IN NY sR+atAc+d PR Y for Ine�rt9n a py �`�IQNAL 0 rRs aad b not to a t?PWION the prin 1. vw o �wp r ebltt motor w►�► EX �1Jh11�Y nooiph Y oullwa�nga� �� ac�s� accessary by y llama q RUt)EL N nth the "Aback m�i►dt s � � Other Can tha aald mortya �o X6841 � ivtlky abtnon "f menti of bin to a h �a�tnsiloh >rlth Iia r q and lhoi he oo4mm cnart4ay. lhandnp !a Eald mb►t9agar. fc►sl �� vt mayor knProvrmb ttit troy aaros catTIRC.ATION Tck Prapwiy tin" wmmp't qa �ti, 1. PMPWiY k hot In a Flood H=rd Am. fhb orr Kt tion 4 basad aro %h• It m%ul of try tnortcen 13L Prop�y b In 'a F100a V^%4W M� of ath j ft Boas not.�xumt a p vwty may' ark" q a Infotm0 on I: lhwfdd4ftt U At�rtnTtta Flood Ha7tmrd. affaeta �ha�tt oro not to by used for the wlsrbtlwys th of F1oed }los�d datetrtllh�d t vtia ice{ fbdaral Nt�od tnwrat,cr Rdts Mop Pdnolf 61. Town of North Andover Building Department �7 Charles Street North Andover, MA. 01845 e �._ D. Robert Nlcetta �Ss�cr.us jig Building Commissioner (978) 688-9545 "..'(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION FoOlL f'• 03-?- O o 3-7 Number St)re)et/Address Map/lot ,.HOMEOWNER �,�MCfII�JV�Ii� Y �"'d��— 1 D D/� —� � �3 Name Home Phone �� Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individuatfor hire who does, not possess a license, provided that the owner acts as supervisor. (State Building 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 it 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_ HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL NORTF1 o 4 over Town ; 0 No. z - - � o �_ `A, o over, Mass., 6a1 r2 042 COC HICHEWICK 7�S RATED 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.�� ., .... ... ... . ►..lb .� .!V.N..r........ ..V..h. t. !... ........................ Foundation C p �c �1 has permission to erect.....�..P.I.�.....�. buildings on ..�..........�....................�................................................ Rough N p D C Chimney to be occupied as....T>v.plewe .. . .......O..y..........��if....�.....�.......d....:.g..N..............�.......�............. provided that the person accepting this�ermit shall in every respect coliform 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. a r)/3*7 $ s PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ......... .A. C............ `.......... .................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wali To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Locations No. Date . ! TOWN OF NORTH ANDOVER t t� Certificate of Occupancy $ Building/Frame Permit Fee ._: $ -7 Foundation Permit Fee $ Other Permit Fee $ '� TOTAL $ Check it 25334 Building Inspector ::1