Loading...
HomeMy WebLinkAboutMiscellaneous - 41 HAWTHORNE PLACE 4/30/2018 41HAWTHORNE PLACE 210/026.0-0016-0000.0 Location 4 No. Date „pRT1y TOWN OF NORTH ANDOVER •�OOA „ Certificate of Occupancy $ " Building/Frame Permit Fee $ Foundation Permit Fee $ _Lw slCHus< Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 154.pp ppID 1031110 C.1_J B ding Inspector 39 8842 Div. Public Works Location s g� k2z�- ekarc,;7 ! No. Date 9—Z6—� I NCRTK TOWN OF NORTH ANDOVER O �t't` O '1tiG EE 1 04 p Certificate of Occupancy $ 0 i Building/Frame Permit Fee $ Foundatiori-,I.Vrmit Fee $ -= ,JSACMUSEt Other Pern�)t Fee $ : e?7 7 Sewer Connection Fee $ !�� water Con ection FQe $ d77• Nj tz 1 TOTAL h. i� $ 0 0 ng In t x - -C 8954 , o . PdKic works Location E No. Date lblkalsr MpRTM TOWN OF NORTH ANDOVER pttt.ao 'a,'VO Certificate of Occupancy $ t Building/Frame Permit Fee $ 9 0c) of CMuSE< Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ i 1 Z9'� Building Inspector C� 10/16 95 14:35 900,00 PAID 8843 Div. Public Works PERJIIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. �f�+M, lNV� PAGE 1 MAP K.10. I LOT NO. �� RECORD OF OWNERSHIP DATE BOOK ;PAGE ZON SUB DIV. LOT NO. � �Ii9 { LOCATION ,1 /J� OSE OF BUILDING ( Q •`OWNQR'S NAME NO. OF STORIES GSIZE rA� ! � C/ Y l v!/ �l OWNER'S ADDRESS Llao L"e w- �- - BASEMENT OR SLAB �� � -{l ARCHITECT'S NAME V 26k S 49-�- SIZE OF FLOOR TIMBERS IST n JD2ND 1//� G 67 3RD dC / • BUILDER'S NAME /' 6(-) I c SPAN 13-J•'1 DISTANCE TO NEAREST BUILDING p��J f DIMENSIONS OF SILLS DISTANCE FROM STREET qlo "T I _ 'Y�Ci I POSTS DISTANCE FROM LOT LINES-'SIDES l.. REAR GIRDERS L/�/T "1 AREA OF LOTQ.(1/i FRONTAGE 9. �� HEIGHT OF FOUNDATION (^' THICKNESS l/ IS BUILDING NEW + 'GG✓✓CJ[" SIZE OF FOOTING 7T , X s7 IS BUILDING ADDITION V _7D MATERIAL OF CHIMNEY IS BUILDING ALTERATION D IS BUILDING ON SOLID OR FI ED LAND 549['l WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Lds IS BUILDING CONNECTED TO TOWN WATER J ti e5 BOARD OF APPEALS ACTION. IF ANY LYI / e IS BUILDING CONNECTED TO TOWN SEWER �/ 1/eC IS BUILDING CONNECTED TO NATURAL GAS LINE P INSTRUCTIONS PERMIT FOR FOUNDATION ONLY 3 PROPERTY INFORMATION REGULATED BY PARA. 114.8-S. B.C. LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST, BLDG. COST PER SQ. PAGE 2 FILL OUT SECTIONS 1 - 12 DATE FEE PAID — I. EST. BLDG. COST PER ROOM ll�� It PrN SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED SX-AM41LDING INSPECTOR DATE FILED_ lC✓ �S BUILDING INGPKCTOR SIGNATUjfE dF OWN9 �HoAGENT FEE C OWNERTEL.N 7� © / PERMIT GRANTED �,o PERAaFOR FRAME/BUILDING CONTR.TEL.# h 7e 10 `7 19 DATE: «0 QA--FEE PAID._._-.- CONTR.LIC.# !J S J SEP 2 T hc,, H.I.C.# BLDG. PERMIT FEE� GO O -- �,� ~CZ�'�7•a't� LESS FDA FEE loo — tnbEFRAME PERMIT_ q*, BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY ISTORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. e CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH r CONCRETE _ B 1 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE HAROW D —_ _ PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA _ 1/1 1/1 '/ FIN. ATTIC AREA N_O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD\IJ'D ASBESTOS SIDING _ COM/,CCN VERT. SIDING AS—PI.TILE STUCCO ON MASONRY e — a, 1 + STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. 8 FLOOR I_ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME '- SUPERIOR I� POOR ADEQUATE ;ONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. )2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING _ WOOD JOIST PIPELESS FURNACE �'' ^•4P FORCED HOT AIR FURN. _ TIMBER BMS. 8 COLS. STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR , r WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS T 'y OIL ! B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING Al AGI "9231 NORTH Tow 0i o . . 6 Andover No. 479 0A Or dover, Mass., 2RDN' ?,8 COCHICHE-iC /jam 0&ATED P' BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT....OAk!K.......7T'Q+.e0� .!.L'T......................................................................................I.............. BUILDING INSPECTOR -4 A. ��00 ( �0 (QD �.ol �c�� has permission to erect.WOO:�....VVAPAP-.. buildings on ..... ..t....... . . .I!Arr .......il. ......... . .. Rough to be occupied as. . Chimney q .6 ... ..................... this -I"rmi. Uli n)ever vke�r-y�k)r provided that the person accepting s p espe form to the terms of thea on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of ina l2 Buildings In the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. J Rough PERMIT EXPIRES IN 6 MON_M0t12_8 4T_ FEE FEE PAID Final P UNLESS CONS ON S ELECTRICAL INSXCTOR Rough OW ......... ......................................... ........... Service t c( BUILDING INSECTOR Occupancy Permit Required to Occupy BuildingS INSPECTOR lovl-& Final Display in a Conspicuous Place on the Premises — Do Not Remove 09h No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Der. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT S-2T _ , :FORK IY —. IAT RELEASE FORK - INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from-Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state lav, regulations or requ *p�ents. ****************Applicant'}fills out -this section***************** C00idge Construction Co. APPLICANT: apt Andover Street Phone a over,MA 01845 LOCATION: Assessor's Map Number Parcel Subdivision 1 p Lots) A Street t. Number r' Use Only************************ RECOMMENDATIONS OF GENTS: r Date Approved L2O �S Cnrse_-r a __4 n. n.. Adm_4 n..-4 __._.-_�}_. - I_ na .o Ro; e___ Comments i Date Approved '} �~ Town Planner Date Rejected VIL Co::�^.ie_^.ts Date Approved Food Inspector-Health Date Rejected Date Approved aG! Septic inspec or-Heal ti: Date Rejected Comments Public Works - sewer/water connections * -�lJ - driveway permit / 9.5 Fire Department �~� � L� ���(/ 11^1 Received by Building Inspector Date r SEP 2 6 _-- �w 559 i ~ 9 QC C I 580 581 560 1240 8CE0.08 6C i SC 05 8.40 51.08 1 2 1.0 H -SET 242 218 2 9• / I.R.SET T.B.M.#3 r SPIKE SETI 1'UP I 30" OAK 237 I EL.=39.45 USGS 51.08 I I 20.06' I 567 565 20,00' 6cr7s o� 3s.00 �' 306_) I 20.00'"Z-0'0/s 20.00' / I � 3s.00' 59 r 566 I I 30g} 75 1 1 V / _ I I I 9 1 / I , I r 1 / 3 __ H&T SET HAWTHORNE PLAGi 169 rp cn-u \ I EXISTING �: z FOUNDATION — 48.8' ti TOP OF I FOUNDATION z o i = 48.0' -' I / Lor 7 POL O T 8A 94' DRAINAGE / EASEMENT_ J / " o / 0 LOT 2A \ . I 75' STRUCTURE LOCATION PLAN T;£HTORIZONTALTHAT TSETBACKAREQUIREMENTS OFSTRUCTURE OTH£ LOWN CALRMS TO APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. . (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS,WETLANDS,EASEMENTS, CLIENT: COOLIDGE REALTY TRUST ORDERS OF CONDITIONS,ETC.) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY THIS CERTIFICATION /S MADE AND LIMITED PURPOSE OTHER THAN THAT OU77JNED ABOVE,EXCEPT NH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. TO THE ABOVE CLIENT. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBITED.CHRISTIANSEN & SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF HIS DRAWING OR ANY INFOR- MATION CONTAINED HEREON. LOCATION: LOT 8A HAWTHORNE PLACE NORTH ANDOVER, MA. SCALE: 1" = 40' DATE: OCTOBER 11, 1995 �LtH of s � U CHRISTIANSEN &SERGI PROFESSIONAL ENGINEERS r� Rt7 LAND SURVEYORS 160 SUMMER ST. HAVERHILL,MA. 018JO TEL 508-373-0310 ©1994 BY CHRISTIANSEN & SERGI INC. RA WING No. 94090008 RTH 1 l ,,, Town oar 6 c .over s . q . No. 479 ' dover, Mass. qcevT 0 ': LA.At I' t A (U(111(rIt WIC., � I `7 �0RATED PPS\ BOARD OF HEALTH Food/Kitchen P.eD I t r $6 ptic SE R. MIT T yst m { t BUILDING INSPECTOR THIS CERTIFIES THAT....`.... :.......... ..!!y.'....:....!.......................................................... ....... ...... 1 oundation 100i has permission to erect..�!......:.:........!................... buildings on....................................A......................................................... orfs G'tWL0j-%C(@ to be occupied as.... ' I� { fmney --' .................................................................................................................................................................... provided that the person accepting this permit shall In every respect conform to the terms of the application on file in in L Lq�c this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of "y Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR, REGULATED BY PARA. 114.8.1 B.G. VIOLATION of the Zoning or Building Regulations Voids this Permit. '� FEE PAID `. . i � ' ' .YGt. �� PERMIT EXPIRES IN 6 MONW -; a 'bZ ELE ICAL SP ` f ,� - .�r., •• UNLESS CONSTRUCTION STARTS , rr f �. �i r "r PERMIT FOR FR UBUILDINGService y BUILDING INSPECTOR ` incl ` DIKE: o t PAID..�g0 f� .( 1♦, f. Occupancy Permit Required to Occupy Building GAS INSPECTOR x w Rough lsplay1n rConspicuous,Place on the Premises — Do Not Remove F at No Lathln or D Wall To-Be Done 9 FIRE bEPARTMENT y Until Inspected and Approved by the Building Inspector. J Burner .{ .' 18 jq--s— 4`.,, Street No.0 A� t'-& ,4,. PLANNING �- `FINAL CONSERVATION ,• _;(,.��,�. tr -; ; I Smoke Det.0 ' 7�c� ' • f ' SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT CERTIFICATE OF USE & OCCUPANCY Town of North Andover ' Building Permit Number Date�C�g� M a 1c&Z, F i 5t t t } *' THIS CERTIFIES THAT ju�,i ' 4 /f��r. rW J V N��� 'ED`ON` l -l�Avsr�4ae B ING L F- PL Aye f' u MAY'BE'OCCUPIED AS. EACCORDANCE 1,'.;r: , Wi WITH'THE PROVISIONS OF THE MASSACHUSTTS TATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. " .rte CERTIFICATE ISSUED TO _8A V- J fJ,ck x ADD , z t f �.• i• 4 41 �p 1 . �j 1 Y t �C� ;i . Building Inspector �' t{ I •� t ' I j ' 17771 { Date..................................... HORT#t °�,•``°:°'"� TOWN OF NORTH ANDOVER °c o p PERMIT FOR WIRING �,SSACMUS� F This certifies that ... ;.,... `.' ` `-t :F.:.....f has permission to perforin-. ,? "� -� :: -t ................................................. wiring in the building ...... :...r: . .................................... at.................. .......-� .... : .... r r ........ .. ,North Andover,Mass. Fees .,� ° .. Lic.No` ... ............ . �� ...... F ELECTRICAL Ir�sPecro Check ��`�� ` Qa '\ Commonwealth of Massachusetts Official Use Only 4 f ' Department of Fire Services Permit No. / i y Occupancy and Fee Checked - -"\ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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 W INK OR TYPE ALL INFOJI 1 TJON) Date: I-J� D V U City or Town of: NORTH ANDOVER To the Ins ector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number)_ f.f � �� - �2 1-17 e— / Owner or Tenant ��— Telephone No. Owner's Address Is this permit in conjnncti n with a banding permit? Purpose of Building _ Yes �No ❑ (Check Appropriate Boz) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und d 1�' ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: n 1J �nz r —�dnr f� Completion of—thy ollowin table may be waived by the Inspector a Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers "7A No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 3 Swimming Pool Above ❑ In- o.o mergency ig o d. d. Battery Units No.of Receptacle Outlets I Z-1 No. of Oil Burners FIRE ALARA S. .No. of Zones No.of Switches No. of Gas Burners No.of etection and 1 Initis ' Devices No.of RangesNo of Air Cond. Total Tons No. of Alerting Devices No.of Waste Disposers Heat Pump Number ons KW ` p Totals: - o•of Self:Contained Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW ��❑ Mun icipal un Connection El Other No.of Dryers / Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW Si s Ballasts . Data Wuzng; No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications icing: OTHER: No.of Devices or E uivalent Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. _(When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon.completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue.unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantia]'equivalent The undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office.. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and pen�f per,ju?,,that the information on this application is true and complete. FIRM NAME: �G _ ` LIC.NO.: J�3/ Licensee: �� Suture (If applicable, enter "exempt"in a license number line) LIC.NO.:����3 j Address: J. 1 I Bus.Tel.No.: 9 7f—3Gelfl 4 *Per M.G.L c. 147,s.57-61,sec work wires D „ „ Alt Tel.No.: req Department of Public Safety S License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement I am the(check one)❑owner ❑owner's agent Owner/Agent Signature Telephone No. PERMIT FEE: Q �Z.�S P9-4� r T -z The Common wealth of Massachusetts ! Department of Industrial Accidents y t Office of Investigations " '' 600 Washington Street Boston, MA 02111 { ` www massgov/dia Workers' Compensation Inshrance Affidavit: Builders/Contractors/Electricians/Pfambers Applicant Information Please Print Legjbiv Name(Business/Organizafion/Individual): —� Address: City/<State/Zig:_&�_I////r-. Phone #: . J� l —���— ��t� Are you an employer?Check the appropriate box: ' L❑ f im a employer with 4, T ype ofp(required): ❑ I am a general contractor and I construction �,/>rmFloyees(full and/or part-time).*. have hired the sub-contractors2.ij�J I am e.sole proprietor.or partner_ listed on the attached sheet deling ship and have no employees 7bese subcontractors have . D Demolition working for me in any capacity, workers' comp.insurance.. [No work='comp.insurance S. ❑ We are a corporation and its . 9 ❑Building addition required.] officers have exercised their 10.E3 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I Plumbing repairs or additions myself.(No-workers'comp. c..152, §I(4),and we have no 12.0 Roof repair, insurance required.]t employees. [No workers' comp. insurance requiml] 13.❑Other 'Any applicant that checks ba#I must also fill out the section below showing their workers'compensation policy in t Homeowners who submit this affidavit indic:eting they are doing an work and then hire outside contractors must submit a new affidavit indicating Ruch. 4contractors that check this box mustattsehed an additional sheer showing the mune of the sub-contractom and their workers'comp.policy infunnetion. I ant an employer that_is providutg:workers'compensa.don insurance for my.employees: Below u the policy and job site informadorc Insurance Company Name: ' 7 Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address—City/State/zip: Attach a copy of the.workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of top to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby cerYi under the pains nd penalties of perjury that the information provided above is true and correct Si ature: �l Date: 1;00 Phone#: 7�— FBoard e only. Do not write in this area,to be completed lry city or town nfficiaL — wn: ^ Permit/License# thority(circle one): f Health 2. Building Department 3.Cityl3'owu Clerk 4. Electrical Inspector 5.Plumbing Inspdxtorrson• Phone# Information and Instructions TV y 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 ofthe'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 anti]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 nuurnber•(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.am requimd to obtain a workers' compensation policy,please call the Department at the number.listed below. Self-insured companies should enL-T their_ self insurance"license number on the•appropriate lim. 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 vvilI be used as a reference number. In addition,an applicant that must submit multiple permit/iicense applications in any given year,need only submit one affidavit indicating•cw=t policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town),"A copy ofthe 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 Where a home owner or citizen is obtaining g 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 Mike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give as a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents i Office of Investi rations 600 Washington Stieet Bas ton, MA 02111 Tel.9 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.gov/dia Date. . . �. R'N TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Swc�us t This certifies that . . . : . .S . . . . . : , . . '. . . ., has permission to perform . . . plumbing in the buildings of . . . . . . . . . . . . . . . at . . ./l�.'.'. . . . . . . . . . . . . . . .: North Andover, Mass. i / PL MBING INSPECTOR Check # 7706 f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS lo't— Date g —I l r Z L Building Location �✓ o��L Owners Name A /' Permit# a /Z� Amount Type of Occupancy New ri Renovation Replacement Plans Submitted Yes ❑ No FIXTURES W. U I p O W O N H O x RtWVE yr M FLOCIR M H-OCIR 4MFOCIR sly ROCIR sMR,M - 7MffiaR (Print or type) PZ4�fo ) ��-vM / Check one: Certificate Installing Company Name N �✓ ❑ Corp. Address4-0 Partner. useless Telephone o� 7 T 77-7-6> _ o t F Z aFirm/Co. Name of Licensed Plumber: IJU✓S/ CJ r/��C.J o r�-� Insurance Coverage: Indicate the type of inAirance coverage by checking the appropriate box: Liability insurance policy LLQ Other type of indemnityElBond ❑ Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in ab ve application are true and accurate to the best of my knowledge and that all plumbing work and i llatio s performed un r P t Issued for this application will be in compliance with all pertinent provisions of the Massa hu tts tate Plumbin ode ha ter 142 of the General Laws. B y: SignaLure o icense um er Type of Plumbing License e Z Zv 73 /Town Dcense NumDer Master ❑ Journeyman USE ONLY Date..��.�• �.?�.. ... .. TOWN OF NORTH A�NDOV A O AN D " • - PERMIT FOR GAS INSTALLATION . -.� ,SSACIUSEtS FThis certifies that . . . .. /. . F . . . . . . . . . . . . . . . . has permission for gas in the buildings of . . -(.� .Z.T.{z. 5. . . . . . . . ... . . . . . . . . . . . . . . at . .�� . . . . .f? !te l r. . . .. . . . . . . , North-Andover, Mass. Fee. .3"-. Lic. No..2.t`. 7.?. . GAS INSPECTOR Check# v tis . MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FfITIN G (y, (Type or print) Date 2 WO NORTH ANDOVER, MASSA HUSETTS Building Locations Permit# Amount$ 3� Owner's Name ��`���� New Renovation Replacement Plans Submitted w w . a a a� I I a F c z w w o I °o z F z U W x v, z dFd a O > W C7 F Z F d W C w C w F w F x C Z Q W Q z E. w U p > W E, U .a w M z o x o x 3 0 .4 o cc > o off, Iw- o SUB-BA SEM ENT BASEM ENT 1ST. FLOOR 2ND . FLOOR <s 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) q Name "f d M / ti Check one: Certificate Installing Company Corp. Address D D 1x M t Partner. Business I a ep one Name of Licensed Plumber or Gas Fitter F f INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes No� If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D 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 13 Agent 13 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 perfor ed under Permit Issue for this application will be in compliance with all pertinent provisions of the Massachuse Gas ode and Chapt 14 the General Laws. By: nature o Licensed Plumber Or Gas Fitter Title Plumber Z- 2-07 City/Town, [3 Gas Fitter (cense um Number Master APPROVED(OFFICE USE ONLY) Journeyman t Date....l..Z.�/7 ... Y HORTM "� TOWN OF NORTH ANDOVER 3? •� °t ' PERMIT FOR WIRING �,SSACMUS� This certifies that ...4.6 r T ....... ................. ......... ........ has permission to perform ........ ................ wiring in the building of ;r *� at.............. r.................. ,NortAndover,Mass. 3. Fee... 6 ... . -c �6' �.. Lic.No. . ............... ..... ......................... ..... ELEcrRICALINSPECTOR Check # 7104 A Official Usc Only • Commonwealth of Massachusetts �� ,Permit No. Department of Fire Services -- - Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS — „S (Rev. 9/05}• (►cave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52.7 CMR 12.00 (PLEASE PRINT ININ.K OR.TYPE ALL INFORMATION) Date: '/3 City or. To,.vn of:. rV d ,yi1bu( I\— To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) R.�jc Q � rolJixk;'t) P �17z Cy 7's Oivne yr Tenant Telephone No. Owner's Address is this permit'in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No, Existing Service Amps / Volts Overhead Undgrd Ll No. of Meters New Service Amps / Volts Overhead ❑ •Undgrd ❑ No. of Meters _ Number of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work: Installation of Security and or Fire alarm systems . t/1j 111-t. S S, Completion o rhe ollowin !able may be waived by the Inspector of Wires. ' No. of Recessed Luminaires No. of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA. No. of Luminaire Outlets No. of Hot Tubs Generators • K•VA Above In- o. o mergency rg:Cng �. No. of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Batter TJnits _ No. of Receptac le Outlets No. of Oil Burners FIRE.ALARMS No. of Zones No. ol'Switches No. of Gas Burners.. o. oCDtand Initiatinng Devices _ No. of Ranges No. of Air Cond. Tonst No. of Alerting Devices Heat Pump Dumber Tons K No. of Self-Coniained No. oCWaste Disposers _...._...__. ._____r • Totals: ���� �• Detection/Alerting Devices Municipal No. of Dishwashers SpaceiArea Heating KW Local-[-1 Con nec:ron C1 Otli'er Heating Appliances Security Syysterns-'' / No. of Dryers g PP KW No.of Devices or EQl;rvalent I o. of Water KW No of wV -No. of- ---- Data Wiring: Heaters Signs Ballasts No.of Devices or E uivaient No. Hydromassage Total HP a Bathtubs No. of Motors oa ' Telecommunications Wiring: x Y g No. of Devices or E uiva!ent I OT H Ell: Attach additional derail if desired, or•as required by the Inspector or{Vires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: j� inspections to be requested in accordance with MEC Rule 10, and upon cornpletion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proo'of liability insurance including"completed operation"coverage or its substantia; equivalent. The undersigned certifies that such coverage is'in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER [I (Specify:) I certify, uu der the pains anti penalties of perjury, that the information on this application is true and cot nplele. FIRM NAME: ADT Security Services, Inc. LIC. NO.: 1533 C _ Licensee: Kenny Wong Signature r� LIC. NO.: 5966D (if applicable. enter "exempt"in the license number line.) Bus.Tel. No.: 603--5,94-5900— Address 18 Clinton Drive Hollis N.H. 03049 Alt. Tel. No.: 603-594-593_ *Security System Contractor License required for this work; if applicable, enter the license number here: SS CC 001975 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normal,y required by law. By my signature below, I hereby waive this requirement. .1 am the(check one) ❑ owner 0 owner's agcvt".'� Owner/,fluentrl >;nr.rrr i7i7n,- z 7_5 I i ��io w/�U`'� �l � f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Typal / z NORTH ANDOVER, . Masa. Oats Bunding i i 4 ��/' /� � Q � / Permit Location G� "O G- Owneklilr.' Gt'�� CANS - Name � New 12/ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No p FIXTURES ws 19 < » W A • u s • s ue s ss'm Ist f' Is o a; • a • • O < • et 0 < r • o J = a •' a ►- �- a et �t < • a s 3 s 1 r w io ioSss a » st s OU os Q0< s DIM H 16 D a o . I s iu io01 e�sissaMT 1sT FLOOR 2H0FLOOR 3r10 FLOOR 4TH FLOOR aTH FLOOR OTH FLOOR. TTH FLO0f1 9TH FLOOR — q / // Check one: Certk1cate Installing 1 pany ame `� �?� yp/N q ❑Corp. Address d D. ❑Partnership �7 E'J Firm/Co. Business Telephone .Name of Licensed Plumber INSURANCE COVERAGE: Checx one 1 have a current ilabilty Insurance policy or Its substantial equWenL Yes U/ No ❑ If you have checked Yom, please indicate the type coverage by checking the appropriate box A IlabilRy Insurance poilcy O Other type of kndemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: i am aware that the licensee does not have the Insurance coverage required by Chapter 112 of the Mass. General Laws, and that my algnature on this permit application waives this requirement.. Check one: store of Owner a Ownet s Agent Owner ❑ Agent p 1 hereby certiy that all of the delaAs and lntamatlon i hays submitted for entered)In above application are true and accurate to the best of my knowledge and that atl plumbing work and Instaltallons parformad under the perrrA Issued for this as wu7 bo In compliance with aA pertinent provislons of the Massachusetts State Plumbinq Code and Chaptar 112 of the si ey Signatme o4 Ucensed Plumbu Title t k nse Number Ctty/Town Type of Prumbing Ucansc Master Ly' APr'rXMD(OFF)CE USE ONLY) Journeyman 0 Datez. . . . . . . f HORTM 4 O TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSAc"us6� This certifies that . ..... .... . . . . . . . ... . . . . . . . . . . has permission to perform . . .f:' %C. - .. . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . .� . . . . . . . . . . . . . . . . . . . . . . . at. ..> . .. . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee./. . . . . . .Lic. No.. . . . . .'. . . . . . . . . . . .. .. . . . . . .r. . . . . . . . .. . . PLUMBING INSPECTOR 10/06!95 14:37 125.04 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File