HomeMy WebLinkAboutMiscellaneous - 42 PROSPECT STREET 4/30/2018 42 PROSPECT STREET
210/081.0-0029-0000.0
1
i j
Date......................................
AORT#1
0 TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
4TW
CHU
...........................................
This certifies that .............. v....... .. ..
has permission to perform .......... .....P .............................................
wiring in the building of..........kn ........................................................
at ...4/-z... ...........S?7-n. ........I North Andover,Mass.
ev,
No. .��21..771'!Z� 'd.......
.1..............
Fee..��5�.....Lic :-r7. . .... ....
WE *
LECTRR�jZ 1&�SP�E�C�T R
Check
1,2.6 15
Commonwealth of Massachusetts Official Use Only
�= Permit No. I �'
Department of Fire Services
Occupancy and Fee Checked
�N 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 INNK OR TYPE ALL INFORMATION) Date:
City or Town of: NORTH ANDOVER 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)
Owner or Tenant k Telephone No.
Owner's Address 41�2_ e.¢ F, V
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❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed-Electrical Work: Z> � -
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of CeilSusp.(Paddle)Fans No.of Total
:
Transformers_ KVA
No.of Luminaire Outlets No.of Hot Tubs Generators A
# No.of Luminaires Swimming Pool Above [jIn- F] o.o mergency ig ting
rnd. rnd. Batter Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS,' No, of Zones
No.of SwitchesNo.of Gas Burners No.of Detection and
�o Initiating Devices
No.of Ranges No.of Air Cond. Total Tons g 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 Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:* E
No.of Water No.of No.of No.of Devices or Equivalent
i
Heaters ' Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
} Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.) y
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 substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCEK BOND El OTHER F1 (Specify:).
I certify,under the pains and enalties ofperjury,that the information on this application is true and complete.
FIRM NAME: . LIC.NO.:
Licensee:_ Signatu re ~LIC.NO.:A/2a& -s�-
(If applicable, ter "exempt"in the license number line) Bus.Tel.No.:,?M 5toq- �?C�
Address: 6u r s Alt.Tel.No.:
*Per M.G.L c. 147,s.57-61,security work requires 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
FPPRI�iTFEE: $
Signature Telephone No.
I
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c. 143,§3L,the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed t
on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the 4
notification of completion of the work as required in M.G.L.c.143,§3L.
Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written
application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was
"in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012.
❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑
❑Permit Extension Act—Permit/Date Closed:
Trench Inspection
Pass Failed 0 Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: U E Date: —/
SERVICE INSPECTION:
Pass 0 Failed 0 Re-Inspection Required($.) ❑
Inspectors Comments:
E
ti
i
Inspectors Signature: Date:
PARTIAL ROUGH INSPECTION:
Pass Failed IN Re-Inspection Required($.)❑
Inspectors Comments:
I
r Inspectors Signature: Date:
ROUGH INSPECTION:
Pass 0 Failed Re-Inspection Required($.) ❑
Inspectors Comments:
it
Inspectors Signature: Date:
FINAL V,SPEC ION:
Pass Failed 0 Re-Inspection Required($.) ❑
Inspect omme /
T
Inspectors Signature: Date:
I
DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com
l
The Commonwealth of Massachusetts
Department of Industrial Accidents
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):
Address:_
City/State/Zip: C Alkd�Phone#:��'rf ) 8a ->2O
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
mployees(fall and/or part-time).* have hired the sub-contractors
e c # 7. E]Remodeling
2. listed o am a sole proprietor or partner- nth attached sheet.
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. g F1 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.❑Plumbing repairs or additions
myself. o workers' comp. c. 152, 1(4),and we have no
Y [N p § 12.❑Roof repairs
insurance required.]i 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 are 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.
lam 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.Lic.#: 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
;[fie 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
Jhvestigations of the DIA for insurance coverage verification.
I do hereby cerci the pains andpe 'es of perjury that the information provided above is it a and correct.
Simature: Date:
Phone#: x'78" �c�^ 3� g
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.PIumbing 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 agencyshall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced-acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial s
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should r
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 h
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 ofladustrial.accidents
Office of Iavestigations
6.00 Washington S-treet
Boston,MA 02111
`Fel,#617-727-4900 ext 406 or 1-87771ASS.A.FF
Revised 5-26-05 Faz,##617-727-7749
www.mass,gov1dia
i
Commonwealth of Mas usetts.
Division of Registrati f,
Board of El ctri
/ RYAN M E
i L 45 ADA
m 'o
LAWREN w
Master Elect 'a
21726-A n, s�iV,
07/31/2016
008835f
s- L.•icense No. Expiration Date.
Serial No.
�f
Location tl tJ
No. Date
NORTH TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
s�CIN �1
Other Permit Feepz $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ S
Building Inspector
tt 32.50. PAID
1.o
6-793 Div. Public Works
PRJiIT,l�n. O APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PA GE 1
MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK 'PAGE
ZONE I SUB DIV. LOT NO. —I
LOCATION �� PURPOSE OF BUILDING
OWNER'S NAME ✓Y1 n C NO. OF STORIES SIZE
WNER'S ADDRESS 1 �L( f C-Cy D� BASEMENT OR SLAB
ARCHITECT'S NAME 1 SIZE OF FLOOR TIMBERS IST 2ND 3RD
UILDER'S NAME e-T�-& SPAN a K g r6 p �C (a Lo, T
iTk Trl-(
DISTANCE TO NEAREST BUILDING V\/ DIMENSIONStl OF SILLS 6'
DISTANCE FROM STREET " K l POSTS
DISTANCE FROM LOT LINES-SIDES REAR ��'($'T6'%j(GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION.til O il �� n0.0 THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
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 SIDES EST. BLDG. COST
I 0,00
PAGE
PAGE 1 FILL OUT SECTIONS 1 - 3
EBT. BLDG. COST PER OQ. FT.
� PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
-
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 BY BUILDING INSPECTOR
DATEi FI D
BOARD OF HEALTH
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E a
0 ,qER TEL.# 1 �'
l! PLANNING BOARD
PERMIT GRANTED CO�ITR.TEL.# � r 3`�7
CQNTR. � L.-
BOARD OF BELECTMEN
`� e/ BUILDING INSPECTOR
. •'t1 s
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS: WITH PORCHES, GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 3 1 2 13
CONCRETE BL'K. PINE
BRICK OR STONE HARDW D
PIERS PIASTER
_ DRY WALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'TAREA _
'/ 1/2 1/1 FIN. ATTIC AREA _
N_O 8 M T FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH
AASBESTOS SIDING COM
SPHALT SIDING HARD\'1'D
_ MON
VERT. SIDING ASPH. TILE
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BILK.
STONE ON MASONRY WIRING
STONE ON FRAME
SUPERIOR II POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING a
GABLE I HIP BATH (3 FIX.)
GAMBREL MANSARD TOILET RM. 12 FIX.) _
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR
I
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
i
I
L7
fence. arou.n el
seW co1
�CLI es
36
q3
_ C
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l
i5 k�rrs y( Cc K �� iJ�rail�nSS
rail�nc�s
H0U.5 L ?ATlC
I-R G
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e
CERT/F/ED FOULV',DA TION PLAN i
LOCATED /N _!l_o rz.-r- ,.� A L,.1 c=> �.•��,
SCALE/"ad=o DATE _�Z(Z(g3
` 50 Deer Meadow Rood
North Andover,Moss. ��
` DoT" �eE� � `QQQ 1 •
E,usr•Hsi Fuo ,,Q
Q2,
7tL
,
1
1
/
CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE
THE OFFSETS OF-THE BUIL DING/NSPEC TOR ONL Y ,U���
SHOWN COMPLY AND SUCH USE/S FOR THEA°
WITH THE ZONING DETERMINATION OFZONING Le y
BY LAWS OF CONFORMITY OR NON-CONFORM/TY N0. 1397
n�r- WHEN CONSTRUCTED. �fcIsTila
WHEN BUILT �aMo
12.12(x3
k
Cc5-! _•axe �`Cf
b� - -
3 _ _ Ve
W/ IV c.Ct-q axe 7o QTS 16
<(�C
axS TOISI oa'ex C
�� 1 s�n�T'�be5 o �z ®r kY
p � - `i !�6 �p h n��yrs
3) --KkK5;of ,o root _
y� (r�c�cs �Y eveur entTor�ce.
® of Q; Andover
VIA
No.
dover, Mass., 19 tV
Q - LAKE
C OC HiC ME WICK � G,
E1)
`tl BOARD OF HEALTH
IT Food/Kitchen
`s
Septic System
PERM T D
BUILDING INSPECTOR
..., /.et,�......�'.� �
.,�.. .........111...........1...............11..........11..........
THIS CERTIFIES THAT...........1111 Foundation
Y has permission to erect.... . .......... buildings on 1111. Rough
� I •
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
E 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 START� ELECTRICAL INSPECTOR
Z
Rough
1111 .. .. ........ .. .. ...... .... ................O......
Service
BUILDING INSPECTR
Final
`
Occupancy P'e1-rnit 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
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT
a p Burner
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
Location—4
3 No. CY'> Date Z2 IS
y
NORTIi TOWN OF NORTH ANDOVER
�... _ OOL Q
ziamaa
" ; Certificate of Occupancy $ a
�. Building/Frame Permit Fee $
Foundation Permit Fee $
�.1CMU5
Other Permit Fee $
Sewer Connection Fee $
Water.Connection Fee $
i9
TOTAL $ ..
Building Inspector
' 4'a Div. Public Works
.:._... ..-e..<.:.<., ,. •�_.s: .._ -.-:_:ter. -v. .... ... .`.... :... Y. ..
PER urr NO._ ,. � APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
:AAP 'i�0. LOT NO. 2 RECORD OF OWNERSHIP �DAT�IBOOK 'PAGE —
ZONE I SUB DIV. LOT NO.
LOCATION ��C.�j�p c-7- PURPOSE OF BUILDING VXT,
, y�j
OWNER'S NAME ljf��2 �'C ® NO. OF STORIES SIIZE�Jl�1
OVIi;;NER'S ADDRESS5�/7 �J�U, �f.. ��� BASEMENT OR SLAB -
ARCHITECT'S NAME G•• / SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME �, � SPAN ---
DISTANCE TO NEAREST BUILDING y / r DIMENSIONS OF SILLS - ---
DISTANCE FROM STREET x f�.ar, N C' POSTS
DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION �elM� r /7 M / IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yQ s IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY YY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
/V �� X �c "D.e LAND COST
SEE BOTH SIDES yp EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
PAGE i FILL OUT SECTIONS 1 - 3 �yE_.
/ U.J /{r G IBJ �` ` EST. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS 1 - 12 (/NP
/-C v e SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
e w ,�! �� G /V 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED/IND APPROVED BY BUILDING INSPECTOR �(
DATE FILED �� �►� ��
.WLDINa INSP[CTOII
SIGNATURE OF OWNER OR AUTHORIZED AGENT
i F E E
OWNER TEL.A`
PERMIT GRANTED CONTR.TEL.N
l r-
2 19
CONTR.LIC.# �
H.I.C.# /4 94/Co
BUILDING RECORD
1 OCCUPANCY 12
r •
SINGLE FAMILYs�ouIES 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.
CONSTRUCTION
2 FOUNDATION —I 8 INTERIOR FINISH
CONCRETE a t 2 13
CONCRETE BL K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER
_ DRY WALL
UNFIN.
I
3 BASEMENT
AREA FULL FIN. B'M'T" AREA _
114 1/7 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 HARDW'D
ASBESTOS SIDING _ COMMCN
VERT. SIDING ASPH. TILE
STUCCO ON MASONRY _
STUCCO ON FRAME r -
BRICK ON MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME
SUPERIOR I I POOR _
ADEQUATE NONE
s
5 ROOF 10 PLUMBING
GABLE I HIP BATH (3 FIX.) _
GAMBRELMANSARD TOILET RM. (2 FIX.)
FLAT I SHED WATER CLOSET _
i
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK `
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _ y
TILE FLOOR
TILE DADO
a
6 FRAMING 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd I NO HEATING
NORTH
p Os1 L overf
"W,
No... 600 *
IV r h �
o � dover, Mass., a�tEmr ,� ZZ 19��
CQCMCHL-CK �
ADRATE D P �C�
1 S BOARD OF HEALTH
Food/Kitchen
Septic SystemPERMIT T. .
E
BUILDING INSPECTOR
THISCERTIFIES THAT.... I ............................................................................................................................ Foundation t
has permission to erect..A. ,................... buildings on . 2-..................PE:¢�............................................:.. Rough
to be occupied asz4 ... >W.�,,..... �.11,�(J�#41�►...h�n
Cl�.�li'1 Chimney
provided that the person accepting this permit sha I in every respecrm tothe 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 s ;
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
tact 4 co Z PERMIT EXP 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CON TR S
Rough
Service
BUILDING INSPECTOR
Final
A Occupancy Permit Required to Occupy Building GAS INSPECTOR
e
Rough
Fr Display in a Conspicuous Place on the Premises — Do Not Remove
Final
No Lathing or Dry Wall To Be.Done FIRE.DEPARTMENT
Until Ins ected and A roved b the Building Inspector
p P p Y 9 p Burner 6 {r T a ct
.. Street No.
t
Smoke Det.
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'"�F
- COMMONWEALTH
Vwr OF DEPARTMENT OF PUBLlC SAFETY Fal/areto
ONE ASHBORTON PLACE Poassasaeo►naf
MASSACHUs-TTS baasaaAus®tear 3tatsaoildlaE
BOSTON,MA 02188 ` `- Codolaaaaref®rr_ 5
.. JLCn q _ artc-
v" LICENSE oltAlsl/eaass.
EXPIRATION DATE CONSTR. SUPERVISOR
CAUTION
12105/1995
RESTRICTIONS EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST
'BONE o 06/30/1993 THEFT, PUT RIGHT THUMB
0 0 515$ PRINT IN APPROPRIATE
J A M i S R F R A H M S BOX ON LICENSE.
2 25 CORINTHIAN DR PO BOX ° _
SS q 389-38-1153 = NO SALEM NH 03073 BLASTING E S
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PHOTO m � � NCL ..
STING OPR ONL �,� 1 E P O -
n
If 0.00
'NOT MALA UNTIL SIGNED BY LICENSEE AND OFFICIALLY
HEIGHT: STAMPED-OR.SIGNATURE�TT+E COMMISSIONER C, s
DOB: L 2 5
12/05/1939
i
THIS DOCUMENT MUST BE -
CARRIED ONTHE PERSON OF -__« SIGN NAME IN FULL
THE HOLDER WHEN EN- TUR E OF LICENSEE ABOVE SIGNATURE LINE.
GAGED IN THIS OCCUPATION.
TONER
�cnemanaaraa,o ✓�l�asa� � __ . .. .. •_ .
HOME IMPROVEMENT CONTRACTOR f � 4
Registration 109462 `
Type - PRIVATE CORPORATION _ y-
'J F iration 09/16/94 {{ -
I F CONSTRUCTION INC o
I AMES 9. f RAHM
2fl CORINTHIAN DRP 0 BOX 14 ;
ADtv4NISTRATCR
N SALEM NH 03073
' F
Only
Use „ y
The Commonwealth of Massachusetts o:lice y �d
- y�— pr rriC �o:
- = Department of Public Safety I
Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 heave 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 INFORMATION) Date a
City or Town of To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
c
Loation (Street & Number) 7 �ossn2C% c�7
Owner or Tenant
Owner's AddressQj12�
Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization NO.—,I-0 F3 S'9
Existing Service Amps /OIa / Z YO Volts Overhead Undgrd❑ No, of Meters
New Service (_O Amps /90 / Z YO Volts Overhead Undgrd❑ No, of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work od RCU /0
No. of Lighting Outlets No. of Hot TubsNo. of Transformers T�Al
No. of Lighting Fixtures Swimming Pool Above In-
grnd. ❑ grnd. F1Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting
Battery Units
No. of Switch ^4)"t=cis No. of Gas Burners FIRE ALARMS No. of Zones
No. of Ranges Total No. of Detection and
g No. of Air Cond. tons Initiating Devices
No. of DisposalsNo. of Heat Total Total
Pumps Tons KW No. of Sounding Devices
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection Sounding Devices
No. of Dryers Heating Devices KW Local❑ Municipal ❑Other
Connection
No. of Water Heaters KW No,ns Ballasts No. of LowWirVoltage
Signg
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current ability Insurance Policy including Completed Operations Coverage or. is substantial
equivalent. YESJ4 NO 0 I have submitted valid proof of same to this office. YES, NO E3
If you have checked YES, please indicate the type of coverage by checking the approp2 to box.
INSURANCE V BOND ❑ OTHER ❑ (Please Specify) 2
Estimated Value of Electrical Work $ Expir tion Date
Work to Start Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM NAZU - LIC. NO. Id l��
Licensee I/ /9 (,pi,'1�/� Signature ` IC. NO. (p�.���
Address t` e ��)e.,�� tnq O�f>v Bus. Tel. No. AOR (oIF3- YJV3cR
ALL. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial 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 S D `�
Signature of Owner or Agent
C0 3clf
M
M Do Not Write In Here
7%,
CA For Electrical Inspector Only
4 Street and No. .............................................
> Name ...........................................................
Z
Electrician ....................................................
PermitNo. ....................................................
Comments ....................................................
......................................................................
`T 4
Date.....�r ..�. ....1.
2739
NORTH
42,
3:00-? 1-6 0 TOWN OF NORTH ANDOVER
O A
PERMIT FOR WIRING a
• sx o
r �++47-
_ �'•
This certifies that ....... ...... ..............................
has permission to perform . . .{ ,.,/�c� f�v�� �2�✓1 d!
wiring//in the building of......5. ......................................... ........:...:.�
CU
at...... �...... !�as��C t Sr
...:... ........ ... ........................................... ,North Andover,Mass.
Fee... (J:: ..... Lic.No.-/........... ......... ............
ELECTRICALINSPECTOR
C �r3q ?
'r;. .
GOLD: File
WHITE:Applicant - CANARY: Building Dept. PINK:Treasurer
2960
Datef .. ....9/A�
1
pORTN TOWN OF NORTH ANDOVER j
Oft..ao ,^,tip
3� y PERMIT FOR GAS INSTALLATION
9
SgACMUSE
f
This certifies that . .? .Z. . . . . • . � •
�!%3
i
has permission for gas installation . .
in the buildings of . . .7 7 . . . . . . . . . . • . • . . . . • . • . . . . . . . •
at . . /. . /'/�c < . . . . . . . . . . . �I� h Andover, Mass.
Lic. No.. t.`./L. . . . . . . . �. . . . . . .
I 14/fe1J8 08:43 15.00 RAID GAS INSPECTOR
F
i
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
aF D�
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFIT nNG I
(Print or Type)
NORTH ANDOVER Mass. Date
�uilding Location ege Permit
Owners Name sem/'%
New '-1 Renovation Replacement Plans Submitted
FIXTURES
m atu
o m r x as
x aa 'jm= zt- t
. o m W. Z ot- zw
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SU11-13SMT.
BASEMENT
t ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7 T FLOOR
STH FLOOR
;Print or Type) Check one: Certificate
Installing Company Name �� L :'N.
Address - - %'� TI Partner._
Fiala/Co.
�..rM.:s-crena .��u.w iK� :aavnv*rnrta,� �z;• 7 .:,. >z. ,r, �..r� i:r war:....�r�aM. ��... rf s n a�a Ys�sw.+uxzrrxterau�.�*nar�eu,.,��w,�^�a-�:Mmd:s x�sarrcrs^auei
Business Telephone: Z
Naine of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Q Other type of indemnity Q Bond E]
' lnsuraAce Waiver: 1 , the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
\M
Signature of owner/agent of property Owner F] Agent El
1 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 perfomed under'Permit iuced for this application witl-be-in oompGance with all pertinent
provisions of the Massachusetts State Cas Code and Chapter 142 of the Genual Lawa. —- •_
By TYPE LICENSE: Al
Plumber w4a/—"
Title Gasfitter Signature of Licensed
City/Town- Master Plumber or Ga atter
Journeyman 'jL
APPROVED (OFFICE USE ONLY) License Number