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Miscellaneous - 43 MEADOW LANE 4/30/2018
43 MEADOW LANE r \ 210/045.F_0018.0000.0 i I t i i I i Date.6 VI I.I j...................... NORTI�,h TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION a 8s,�cMuss This-certifids that �k has permission for gas installation ....... (AU,..�� ... .....4.... inthe buildings of.....n .... .......:�........................................................................... at........ 3..::�:Po`cY�.�?. .......................... North Andover, Mass. Fee A --... Lic. No.c��. � ....... We....................................................... (�� GAS INSPECMR Check# U 5j? 212� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY I North Andover MA DATE 5122/2014 PERMIT# R�Z2 JOBSITE ADDRESS 143 Meadow Ln OWNER'S NAME GOWNER ADDRESS I Same TE FAXI TYPE OR OCCUPANCY TYPE COMMERCIAL[j EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:O REPLACEMENT:® PLANSSUBMITTED: YES❑ NO❑ APPLIANCES 7 FLOORS--- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER .UNVENTED ROOM HEATER WATER HEATER OTHER Replace 1 Gas Meter x and associated ipinq INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co iance with allPerti nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Joseph Marino LICENSE# 8736 SIG AT RE MPEI MGF❑ JP❑ JGF❑ LPGI® CORPORATION Q# 3285C PARTNE HIPF-1# LLC E1# COMPANY NAME: RH White Construction Co ADDRESS 41 Central St CITY I Auburn STATE MA ZIP 01501 TEL 508 832-3295 FAX 508-926-4347 1 CELL 508-832-4614 EMAILJMarino@RHWhite.com Inr ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES L S :C �VitufCBNi(VEAL.:TH OF N9ASS_i .l U _ S - _ - I :; •-=>F?LUI1jBERS AND GAS FITTERS'r •-_ rsr./_ -_ ==°�`•i'f�SUES:CFf•E'�%IHQUE"LI-�ENSEI`'O�'=.:s:-r -:.�: ;'t_- GTON 9T '1:05�E;1'vH. `.D �PZ•A•R.Lt�•Q -.- '° -- -,.c••-.�: �1 GR:cES`7' R MA 0:G.�5 3I Q .9 05/0�.fl�o- - C;OMlu1ONWEAL-TH OF MASSA Igo P:Eul USERS AND GAS FI7fERS E`D AS A JCIU.RNEYMAN-:i-LiJm��r�. TSSUES THE ABOVE LtCEfVSE TARR-P-N GTO N ST 05/01/14 i I ` URD �C ® DATE(MMMONYW �.�--; CERTIFICATE OF LIABILITY INSURANCE Page 1 Of 1 08/29/2013 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the Policy(ios)must be endorsed. If SU13ROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does noteonferrights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT williQ of Massachusetts, Inc. PHONE PAF C/o 26 CQntury Blvd. NQ-EXT: 977-945-7378 _NOS. a88-467-2378 N h Hoe 305195 ft-DDRFM:_ce_rJi9icate Na9k1vi11a, TN 37230-5191 �g3d11ia,Gom INSURER($)AFFORDINGCOVERAGE NAICtl INSURED INSURERA:The chax'tar Oak rix•A Znauranco Company 25615-001 R. R. White Construction Company, Ino, INSURERS: Property Casualty Cost'ti>?any oil Am 25674-003 41 Central Street INSURER c:Natioklal Union P. Sneurnnca company o£ 7.9445-001 P. 0. Box 257 Auburn, MA 01501 INSURERD;Travelers indamnity Company 25658-001 INSURER E; INSURF,R F; COVERAGES CERTIFICATE NUMBER:20267680 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD SUB TYPE OF INSURANCE POLICY NUMBER YOLICYEFF POLICYF,(P LIMITS A GENEiALLIANLITY VTC2000 977X9948-13 9/x/2013 9/1/2014 EACFIOCQURRENCE h 2,000,Q00 COMMERCIAL GENERAL LIAMI.ITY TO RENTF,O i�� � 5_(Eeoceuroncrf _ 300_000 CLAIMS^MADE OCCUR MEDEXP(Anyone ereon $ 10, _goo PERSONAL&ADV INJURY $ 2 QOO,_,000 GENERAL AGGREGATE $ 4_(000 000 GEN'LAGGREGATELIMITAPPLIESPER; PRODUCTS-COMP/QpAGG $ QQQ 000 POLICY PRO- Loc B AUTOMOBILE LIABILITY ax3CAP 977x955A-33 /1/20x3 9/1/2014 OMBI ED5INGLEI,IMIr X ANYAUTO .a;Ctent $ 2,000,000 ALLO NED AUT08ULED BODILY INJURY(Perpemon) is BODILY INJURY(Peraceldont) $ X HIREDAUTOS X NON-OWNED AUTOS eraccldenl $ X Co Ded X Coll Ded C UMBRELUILIAB ROCCUR B>;8766140 9/1/2013 9/1/2014 EACHOCCURRENCE $ 5z000,000 Pa(CESB LIAR CLAIMS-MAGE AGGREGATE $ 5,0001 000 DED I V RETENTIONS 7,0,000 S D WORKERS COMPENSATION ILIT VTRXUB 820571185-13 9/1/20 .3 9/1/2014 X O - ANDEMPLt]YERS'LIABILITY TAR,YLI D ANYICERIM IETORIPARTNFRlFXECU7IVE� N(A VTC2xuB A209.A71A-13 9/7,/2013 9/1/2014 E.L.EACH ACCIDENT s 1,000,000 OFFICERm(EM9ER EXCLUDED? (MLnddgIIbeutloahl E.L.DISEASE-EAEMPI,QYF_E $ 1,000,000 U S Kali!I ION WF UFURATIONS below EJ.,DISEASE.POLICY LIMIT 1 1,000,000 )FSC RIPTION OF OPERATIONS I LOCATIONS I VE141CLES(Avow)Acord 101,AddltonPl Remarks Sehvdula,If more ep sen 16,cequlred) :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Evidence of IaRfuXaslce Coll:4197604 Tp1:1694012 Cea:t;:20267680 ©1988-2010ACORD CORPORATION.All rights reserved' - ,CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD pp Safety Insurance Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N ANDOVER, MA 001845- N ANDOVER, MA 001845- RE: Insured: DEBORAH DEGALLA Property Address: 43 MEADOW LANE,N ANDOVER, MA Policy Number: HMA 0141546 Claim Number: BOS00045151 Date of Loss: 9/6/2014 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Stephen Desrosiers Claim Examiner 9/9/2014 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 5463 Fax: (617) 531-6658 Email: StephenDesrosiers@Safetylnsurance.com Date..1.......:......... .................... NORTh TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU ............................................... This certifies that ............. has permission to perform .... Acy-�, .......................................................................................... wiring in the building of.... C................................................................. rth Andover,Mass. at ...... .................................................... . ...................... orth Andover,Mass. Fee..P,i)�Z**...........Lic. .... ........ 0 h AcrR'IC'A*'L-*I*N*SPE-C-T*0'R Check#Q,A5 I T- a Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. l t��1i Occupancy and Fee Checked aM BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NMC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL.INFORMATIOA9 Date: I U "-Zy1n R 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) (—At) Owner or Tenant � A T>c [7-AL—LA Telephone No. Owner's Address J Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) �1 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: 1C�i Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans TransTotal Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA } No.of Luminaires Swimming Pool Above ❑ In- Elo.o mergency Lighting 1 rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones 14. No.of Switches No.of Gas Burners No.of Detection and Initiating Devices _ No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Dis osers Heat Pumb ump Ner Tons KW _ No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection No.of Dryers Heating Appliances KW SecurityNo.De i es or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications No.of Devices or Equivalent__ OTHER: Attach additional detail if desired,or as required by the Inspector of 97- Estimated Value of Electrical Work: (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 F 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,tinder the ins andpenalties ofperjury,,hat the information on this application is true and complefe. FIRM NAME: . �C C�L�"1� ��-�1 V�y LIC.NO.: Licensee: Signature LIC.NO.: 3 (If applicable,en er "exempt"in the license naimber line.) Bus.Tel.No.: Address: c---04 — -S1 f4MeS ju�- r'n 0 iG)1 Alt.Tel.No.: — �l *Per M.G.L c. 147,s.57-61,security work requires Defartment 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 PERMIT FEE. $ / Signature Telephone No. ❑ 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 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 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 N Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass n Failed [N Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 1;N Failed M Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass F?] Failed M Re-Inspection Required($.) ❑ Inspectors Comments: I Inspectors Signature: Date: FINAL INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comme s: Inspectors Signature: V Date: DEB WEINHOLD ... TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustriqlAccldints Office of Investigations 600 Washington Street Boston,MA 02111 Uf www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/Individual): �L Address: City/State/Zip: Y�V�C-54k- e W)A G)C one#: 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 employees(full and/or part-time).* have hired the sub-contractors 2 ( I am a sole proprietor or partner- listed on the attached sheet. E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. F1 Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [Ido workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.[JOther comp.insurance required.] y' *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. 1 - 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of itivestigations of the DIA for insurance coverage verification. Indo heb cert under the pains and penalties of perjury that the information provided above is true and correct Sim ature: Date: ` 4k r l Phone#: C1-)q I-) 1 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: � Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, t please do not hesitate to give us a call. The Department's address,telephone and fax number: The Conu noxlwealthofMassachwetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 021 I1 TO,#617-727-4900 ext 406 or I-877rMASSAFB Revised 5-26-05 Fax 4 617-727;7749 www.mass,gov7dia Date..... ..I......L.g...`......3....... O�NORrh o?' �, TOWN OF NORTH ANDOVER f � p PERMIT FOR GAS INSTALLATION 88gCMUg� 4 This certifies that ..55. ?........ .. .. .. .1`. ...�............................... has permission for gas installation .. o. .... ......................................... in the buildings of........ . .. ..��..t............................................................................ at......` .3.....CY�n d�c ..................... North Andover, Mass. Fee3 :. O ..... Lic. No.a.y.73......... ...............:.................................................. GAS INSPECTOR Check# 37-7 Y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 64.vGIr/� r-- _ MA DATE —14 :?c��/.�I PERMIT# ct 2. JOBSITE ADDRESS y3 /`� r tJ�c J LOWNER'S NAME GOWNERADDRESS =TE ��FAXr �f TYPE OR OCCUPANCY TYPE COMMERCIAL ' EDUCATIONAL PRINT RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NOQ APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE - DIRECT VENT HEATERVI DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR ^-=- GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN_ POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER � ( i-�_ - ( WATER HEATER OTHER _ INSURANCE COVERAGE - I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY F--jj OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER EI AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn lance withqal]Penent ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME _ CST/t�L _ LICENSE# 7? SIGNATURE MPAfMGF ED JP 0 JGF 0 LPGI ED CORPORATION[]# PAR RSHIP DI# LLC D#�_ COMPANY NAME:TG ?'NC/LS � �ADDRESS CITY STATE MZIP TEL V6 V_ FAX � CELL �AY EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No .0 ?e� '3AV THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ / FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts 07 Department of IntlustriglAccidents Office of Investigations 600 Washington Street Boston,MA 0211.7 www.mass:gov/clia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please PritntLegibly Name(Business/Organization4ndividual): V!/1 �� LAjlr�j�s .Address: 7 f J f e4 dfc r R ct - City/State/Zip:_ 1 o d c y d� Ey�� a?�� Phone#: 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)X have hired the sub-contractors 7 2. I am a sole proprietor or partner- listed on the attached sheet.t . ❑Remodeling ship and'have no employees 'These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c.152,§1(4),and we have no 12,❑Roofrepairs insurance required.]t employees.[No workers' comp.insurance required.] 1311Other *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 Lire doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh 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 tleclaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Xdo Hereby CertWv under the pain ¢nrlpenalties ofperjury that the information provided above is true and correct. - Si afore: G--- Date a — z 8— 3 Phone#: -Tc fYZ Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/I,icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other - - - 'ot,n„o M. 1 t 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 ofhire,• 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 is 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 dwellinghouse of another who employs persons to do maintenance,construction orrepair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along withtheir certificates)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,apolicy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of-insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials --Please be sure thatthe affidavit is-complete•andprinted Iegibly. TheDepathn.erithas 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 inthe permit/license number whichwill 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(ifnecessary)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. Anew affidavit must be filled out each Year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license orpermit 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 quesfions, please do not hesitate to give us a call. The Department's address,telephone anal fax number: Tho ColnjAollwealthofmassachusPUs - Departx ant ofJadustdal AccUouts Q)ft�c�oifln,�estiga�i.Q.�,s 600 Washington Siremt Boston,MA02111 TO,#617-727=4900 eyt 406 or 1-877- A SAFF, Revised S-26-05 FaY,#617-727-7749 Date 1.0.-.z.` 3..... I U J �' F N°RT/f ° ti TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING a°off?`_.';T':•�'•' gBACMUS� This certifies that..... . �.�. j.............{.- ............................................ ........ . ... . 1 .... has permission to perform... c .. ?...... ...................,.. plumbing in the buildings of......D...�...t`.........p:"..�?... ..C. `.!.......................... at.....9....�......... e..s ��?.......L.�t ............................. North Andover, Mass. Fee qP:,�, ....Lic. No.a,. .�..... ............... 3.�..�:... . .. .. ............... .................. PLUMBING INSPE R Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY eJ A!/ ccu� 1 MA DATE !ct -9—/3 ( PERMIT#. 102-3Y JOBSITE ADDRESS �3 PF d•J L� _ _ OWNER'S NAME POWNER ADDRESS1 fl y w h _57A/- C-' TEL __ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL ® RESIDENTIAL KL— PRINT CLEARLY NEW: El' RENOVATION: REPLACEMENTS PLANS SUBMITTED: YES Q 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 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM { ._____{ __... DISHWASHER DRINKING FOUNTAIN t FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK ._.__I ! -__-- LAVATORY ROOF DRAIN 1 _� ( _ _ _--E _ 1 _— _4 _ { ._._ k ._.__._{ _. ._ ! ...___._._( _....__. -ilL--J SHOWER STALL SERVICE/MOP SINK ..-_.__( .____l ___.._j TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _I F .._ ___( { ; _ ( I ( I WATER PIPING _ 1 _( OTHER _---� — I --..._.1 - -( --{ I --- —{ - --._! ... -- I ` - -{ t 1 INSURANCE COVERAGE: µ 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES bpo 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY -�_i OTHER TYPE OF INDEMNITY _! 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. CHECK ONE ONLY: OWNER Q AGENT { SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co pliance with all yerlinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME /I KFS FL�4 T/VE/ZS I LICENSE# 027_3 �~ SIGNATURE IMP JP 0 CORPORATION F.]# PARTNERS 0# _ E LLC E COMPANY NAME Ti�fC2S /�7� ADDRESSi c4U/cs /Z CITY aiS�d�,t/- f STATE —j ZIP 3 86 S TEL 144 FAX E CELL Gso3Co 0 EMAIL i ROUGH PLUMBING INSPECTION NOTES BELOW FOR 6 FIL-t USE ONLY FINAL INSPECTION NOTES Yes No C 3d t11'1 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ ��/ FEE: $ PERMIT# PLAN REVIEW NOTES f The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations Uf 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): �7a�4r 15 Af Address: 7 12 W City/State/Zip: Phone 4:-6 03 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 i mployees(full and/or part-time).* have hired the sub-contractors 24 I am a sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp,insurance. 9. E]Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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. 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.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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert under the pai s and penalties ofperjury that the information provided above is true and correct. - Si ature: -�-- Date: Phone . Ci 6 U-3 (n a 19 6 2 4/C7 tg��e 6 U 9 3f,?-yG V2_ . Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: C Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpubhc 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 Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for:future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 Commonw.ealth of Massachusetts Department of Industrial Accidents Office ofInvestigatious 600 Wasbngton.Street Boston,MA.02111 Tel,#617-7274900 ext 406 or 1-877rMASMFE Revised 5-26-05 Fax#617-727.7749 www.ma5s.gov/dia, r r3 Date.... . NORTH °! ' TOWN OF NORTH ANDOVER * PERMIT FOR WIRING s �,sSACHUs� This certifies that Cr has permission to perform ... /��.. .:-....-..... :: '... .�?, ....... wiring in the building of....�. p � .:-� ................................. ....... :r .'......... . ,North Andover,Mass. Fee\:�.Y. �...... Lic.No 731' ............... LECTRICAL INSPE R � Check # �'f� 8142 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked C-5�S-°" [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 {PLEASE PRINT IN INK OR TYPE ALL MFORMA77OA9 Date: 5/12/2008 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) 43 Meadow Lane Owner or Tenant. Deborah Degalla Telephone No. 978 683-2095 Owner's Address Same Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. 4574782 Existing Service 100 Amps 110/220 Volts Overhead X❑ Undgrd❑ No.of Meters 1 New Service 200 Amps 110/220 Volts Overhead X❑ Undgrd ❑ No.of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Service upgrade to 200 amps and wire central AC. Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA o No.of Lighting Fixtures Swimming Pool Above In- .o Emergency Lighting rnd. rad. EJ Batte Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 Total 4 No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number TonsKW 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: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent i OTHER: J 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 ® BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: $4000.00 (When required by municipal policy.) Work to Start: 5/14/08 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: Hammond Electric,Inc. LIC.NO.: 11011A Licensee: Paul J.Hammond Signature LIC.NO.: 25730E (Ifapplicable,enter "exempt"in the license number line) 4 Bus.Tel.No.: 978-373-9979 Address: 60 Railroad Street Haverhill MA 01835 Alt.Tel.No.: 978-210-1900 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. $ Location ` No. 2 Date NaRTh TOWN OF NORTH ANDOVER •BOO p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation, Permit ee $ cwun Oe�mitFee/ $ 3 ,U Sewer Connection Fee $ Water Connection Fee $ --�- _� TOTAL Building Inspector G 732 65-0 iv. Public Works X147194 09-.44 PF,RAtIT N,*J. ; APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. AGE 1 MAP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE I SUB DIV. LOT NO. LOCATION O, ) L�`J£ PURPOSE OF BUILDING / G-�✓Du�Q c� I!M 1 OWNER'S NAME w ry NO. OF STORIES SIZE ��M I���� 00� r�oBF,�T f X�l.�LFf�cJ /tLLR�1 OWNER'S ADDRESS 021MFApo L ��n BASEMENT OR SLAB - ARCHITECT'S NAME G SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ,�A.M�L �OO L 16 SPAN_ DISTANCE TO NEAREST BUILDING C DIMENSIONS OF SILLS DISTANCE FROM STREET a.� POSTS DISTANCE FROM LOT LINES—SIDES 02 0 REAR 20 / " " 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 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 PAGE 1 FILL OUT SECTIONS 1 - 3 EBT. BLDG. COST PER SQ. 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 t ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH SIGNATURE OF O ER OR AUTHORIZED AGENT FEE rC•� OWNER TEL. 7 9y-03123 PLANNING BOARD PERMIT GRANTED CONTR.TEL.t# �(3 I 19 rf CONTR. LIC.N_ 1/4 3 3r:L BOARD OF SELECTMEN BU ILDI NO INSPECTOR '7 S 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- APARTMENTS I AGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 2 to CONCRETE BL K. PINE BRICK OR STONE HARDWD PIERS PLASTER —{I_ DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M TAREA _ V, 1/2 t/. 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 _ COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING 0 STONE ON FRAME _ SUPERIORI I POOR , ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13BATH 13 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 I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC +� 1st 13rd I NO HEATING L " a a' s' 36' WORK AREA A A A 2' RED pok _ a CD 1-0' m POOL LOCATION G C, ��• t Use Adjustable A-Frame Safety Line ' �lion A = Braces At Wall Joints Indicated By A. A Digging Layout z�DRt SI m , See"Wall Corner Detail" e`�.111�1: +° �`• m NSPI (Typical All Corners) m TYPE II DIMENSIONAL SPECIFICATIONS AS APPLIED TO ``'`E='` +` \j WEATHERKING POOLS or 1. Overhang of diving board from edge of pool is 2'-8 7/8" (±3 inches). _ A 32'-O" A A 2. Water depth under tip of diving board < is a minimum of 72" at Point"A", Plan Note: 3. Maximum board length is 8' -0". Stainless Steel Wall 4. Maximum board height over water is 2' -8 7/8" (f 3") Overhang Distance Panels 41"High. All 20 inches. McaD F.nnO Others 42"High. 5. Diving board must be centered in width +• wr. o `- � I I 20" Maximum �--- 1'-O" of pool. 8 w` c: �� Height Above Water C11'_S6ee 6. Reser to manufacturers'specificationsMinimum Water Levef —SaietyLine for fulcrum locations. 4" Below Top Of Liner 7. Safety lines must be mechanically at- tached on one side supported by '—Undisturbed Earth N "A". Vinyl Linel Overbuoys. ote 2 2" Compacted Sand 8. A step or ladder or other approved means shall be provided at both the shallow and deep ends. FOLLOW ALL APPLICABLE SAFETY AND Profile BUILDING CODES, AS WELL AS INSTALLA- TION INSTRUCTIONS FOR THE POOL 15' 15' /5112' 1511z' AND ALL EQUIPMENT AND ACCESSORIES. CAUTION: DIVE FROM DIVING BOARD ONLY. 16x32 RECT. 16x32 RECT 2-14' SECTIONS 2- 15' SECT/ONS /4 4- 15' SEC nONS /4 15 4 - 15,2' 770N3 /5 WEATHERKING PRODUCTS INC. 4-I PC.900 ROLLED C154NERS 4 - 3 PC.90°CORNERS /0-COP/NG CL/PS l0- COP/NG CLIPS EAST GREENWICH; R.I. I5' 15' 15112' 15v2' DRAwN:AF/H APP' J.P.P. 1$ x 39 x 8 BGT II DATE 12-82 Holiday Coping Layout Snap Strip Coping Layout RECTANGLE NORTHERN ASSOCIATES, INC. z NOP ANDOVER 17A (508)975-7117 Gx 9i&- vjgj - 063 MORTGAGOR.* ROBERT R. 6 KATHLEEN M. GALLANT DEED REF. 299515 L OCA TION.• 92 MEADOW LANE. PLAN REF. 4759 CITY. STATE.* N. ANDOVER MA - SCALE., S— 30' DATE: 3 / 2 / 93 JOB A. 931709 V U 7L' LOT 21 l �j� ao �r a m Lor 22 LOT 15 a Z 38 / b rc �, 2 STORY ------ woos � �• i / a.o I LOT ,14 1 �V >4,4$ ,� L CPc r ►�, I`. �G� �1 CC.h1�7c1 CEpT 97E 7-0* SCi1RCE ONE MORTGAGE SERVICES _ > f FvICP �'C� a"t ( Y l CI / I FURTHER STATE THAT IN MY PROFESSIONAL NOTE: This mortgage inspection was prepared OPINION the principle structurals and accessory specifically for mortgage purposes and Is not to be �N utbuildngs, upon as a survey. Northern Associates, Inc. a pts no CONFORM responsibility for damages resulting from aa' reliance byRID with the setback require"tits,of tho Local zoning anyone other than the said mortgagee an Its assigns in ordinances,and that there e-no encroachments of major connection with its proposed mortgage fi acing b said NATOLI improvements either wa across rorty lines except as ort g tor• No.307W shown. PALL �j Eo ALSO: Da :_ fC�$ � Is not in a Flood Hazard Area. This mortgage inspection was prepared in ansa �NQ �` ® 1.Prop" with the Technical Standards fol Mort go Loan SURA 0 2.Property is in a Flood Hazard Area.' Inspections as adopted by the Massa husatts s$oc D 3,Information is insufficient to determine Flood Hazard. of Land Surveyots and CMI Engineers,Ir& q Flood Hazard determined from latast Federal Flood InmirnmetA PAIA UAA PAM!i NORTH own of "1 f 6 over No. 223 � dower, Mass. 1V4_V_& 1997 Y coC H,c HE wiCK AD RATED '9S I BOARD OF HEALTH RMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT. '. R�, ..... AW i• . '•• Foundation has permission to erect.. 4.4 ............ buildings on ....�.�.��,�!�1��'�.��.-I . Rough to be occupied as.. p / �.... A �...100.• .. .. ................................................... Chimney . . ...... � provided that the person accepting this permit shall in every respect conform to the terms of the application,on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of,the Zoning or Building Regulations Voids this Permit. Rough t ERMIT EXPIRES IN 6 MONTHS Final �f��� ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ic f$voodoo 00 ......... ........... .. .. ..... �.... .. ...... .... .... ..... Service MLDING INSPECTOR Final 1 Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE SUB DIV. LOT NO. I LOCATION PURPOSE OF BUILDING tl4Pl�oA �irDn7Ta 'e'/�vle //JeJ Ndj� Q T ] OWNER'S NAME pd / ) J NO. OF STORIES SIZE �,pOA17' Aoa OWNER'S ADDRESS 3 / uC�yG BASEMENT OR SLAB W,oe siz e ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RDOP.-A)I' BUILDER'S NAME ��iQ�/.0 �- //�J`_/�N9 SPAN DISTANCE TO NEAREST BUILDING C• DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR •• •• GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW N© SIZE OF FOOTING X IS BUILDING ADDITION NQ MATERIAL OF CHIMNEY IS BUILDING ALTERATION \ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENT OF CODE 'V/ f 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 17 3.1? o®, PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. 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 AT ED / GO pr BOARD OF HEALTH SIGNATUA OF OWNER OR AUTHORIZED AGE F E E OWNER TEL PLANNING BOARD PERMIT GRANTED CONTR.TEL. t9 CC'ONTR.LIC.#_da27 fyo- BOARD OF SELECTMEN mulLDING INSPECTOR 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- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE B 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDWD PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'T' AREA _ 1/4 1/2 '/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDV✓'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH.TILE —{I_ STUCCO ON MASONRY �— STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3BATH (3 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) _ FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY - WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES - TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING y 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 NO HEATING ; DEPARTMENT OF PUBLIC SAFETY 1010 COMMONWEALTH AVE. BOSTON,MASS.02215IT ; LICEE CONSTR. SUPERVISOR I EFFECTIVE DATE LIC-NO. 06/30/1991 027489 STEPHEN M KEISLING 31 MIDDLESEX ST N ANDOVER MA 01845 Pi . 02- HOME IMPROVEMENT CONTRACTOR I: Registration 101846 Et," - y ' NOT VALID UNTIL SIGNED SY LICENSEE AND OFFICIALLY Type INDIVIDUAL STAMPED OR SIGNATURE OF THE COMMISSIONER Expiration 06/29/94 D t Stephen M. Keisling ,/ S NATURE OF LJp NSEE 31 Middlesex St _—�_ N. Andover MA 01845 ADMINISTRATOR 5 E W E EIR i'W A T LI FINAL F1,1 ,A L F I IN A L 0 Town of #.1 0 9z n over 0 "N6rd A `16*er, Mass., ZG 19�2. fth' v)� A PER B I LD BOARD OF HEALTH THIS CERTIFIES THAT........ .. . ............ .. .. . .... ........... ......... BUILDING INSPECTOR has permission td*W*111� ...... buildings on ..... .... . .. ... . ..... . . Rough *..yf .j$p1;W I Chimney to be occupied as..... OVAO'.. Final provided that the person accepting this permit shall in every res ect co rm to t e term "of the application on rile in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. I-TIVVIIT EXPIIIES IN G MONTHS ELECTRICAL INSPECTOR C. rr C0 C.— Rough "dft" Service Final GAS INSPECTOR Occup(me-v Pt';-mil' Required to Occip_r fluddlll�.) Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector Location `! {� No. Date MORTIy TOWN OF NORTH ANDOVER .. A Certificate of Occupancy $ • i : ; Building/Frame Permit Fee $ CNUst<� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ o m r Building Inspector iv 1ixW ; o Div. Public Works i Location f No. F `r� Date ��- • �. � --- -- u HORTN TOWN OF NORTH ANDOVER O? •' • OR Certificate of Occupancy $ i Building/Frame Permit Fee $ CHust< Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ 51 Water Connection Fee $ _ n TOTAL $ 3 Building Inspector Div. Public Works �r ✓ PERMIT NO. APPLICATION FOR PERMIT TO BUILD********NORTH ANDOVER, MA . NIAP NO. LOT.NO. © (� 2. RECORD OF OWNERSHIP DATE BOOK PACE ZONE" SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME NO.OF STORIES SIZE OWNER'S ADDRESS 'S` BASEMENT OR SLAB ARCHITECf'S NAME SIZE OF FLOOR TIMBERS j 2� 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF 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 IS BUILDING ON SOLID OR FILLED LAND 7 Will.BUILDING CONFORM TO REWIR ENT$OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION,IF AN IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTUC.TIONS 3. PROPERTY INFORNIATION LAND COST EST.BLDG.COST 1 PAGE I Fill.OUT SECTIONS 1-3 EST.BLDG.COST PER So.FT. EST.BLIXi.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. A ITACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INS TOR i DATE FILED OWNERS TEL# CONTR.TEL# r i CONTR.LIC# (/ SIGNATURE OF OWNER OR AUTHORIZED AGENT FET: $ PERMIT GRANTED 19 a Location No. -� �3 1 Date ,.ORT" TOWN OF NORTH ANDOVER 3? OL Certificate of Occupancy $ Building/Frame Permit Fee $ 'Ss,cM ��UPtheKlPermit ldation�it ee % ,Fee $ Sewer Connection Fee $ JUN 2 .,,9 Water Connection Fee $ 3TOTAL $ r / ;7ZBuilding Inspector ► 6 - —7 Div. Public Works PE&JtIT NO._ s APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. AGE 1 MAP K-4O. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK "PAGE ZONE SUB DIV. LOT NO. I LOCATION ? fs PURPOSE OF BUILDING OWNER'S NAME tJ GNO. OF STORIES OWNER'S ADDRESS //3' / BASEMENT OR SLAB ARCHITECT'S NAME /s SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME s?e-101 .� /it lee CS'6 IAI SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES—SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW X15 SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION i(.Q IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE lies' 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 3a�R PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. 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 DATE FILED BOARD OF HEALTH SIG U E F OW ER OR AU OR ZED A ENT F E E PERMIT GRANTED OWNER TEL.# PLANNING BOARD CONTR.TEL. 6 P2-,2a;;,Z 19 �� CONTR.LIC.N eoZ 2,V BOARD OF SELECTMEN 7 0 SUILDINGIINIFFECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 11 STORIES I 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 $ INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJAIL _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ '/ 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�N'D _ ASBESTOS SIDING _ COMMCN 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 I� POOR _ ADEQUATE NONE r 5 ROOF 10 PLUMBING GABLEHIP BATH Q FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) _ r 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 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 OFFICES OF: Town Of 120 Main Street � APPEALS `�� NORTH ANDOVER North Andover. •� Massachusetts O 1845 BUILDING �'ess<<4° DIVISION OF (617)685.4775 CONSERVATION HEALTH PLANNINGPLANNING & COMMUNITY DEVELOPMENT A KAREN H.P. NELSON, DIRECTOR 6 In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number �2 ...3 g is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: A7 4- -,e A `LI (Location of.Facility) ' i Signature of Pc it Applica Z/ p3 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. NORTH ( E h Town of ��� X > > Andover No. 23 o_15A p dover, Mass., I'm Ad if ' 199. ADRAT E D a BOARD.OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......6.11-49A&A 0Y ... .. �........................................... ....................... Foundation has permission to erect..t..l.1�l..NA!......... buildings on .....��.. >� ..,���..� Rough to be occupied as.. ..��� . .... ...... ... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ..................... Service BUILDING SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RouFinagh No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINALCONSERVATION FINAL Street No. ?Cj Smoke Det. CF1111FR /IAIATFR FINAL r,-) DRIVEWAY ENTRY PERMIT Location No. Date 4 / ,40RTM TOWN OF NORTH ANDOVER p? •s CL „ Certificate of Occupancy $ + Building/Frame Permit Fee $ CHuSEt Foundation Permit Fee $ Other- Permit Fee' $� � tj " Sewer Connection Fee $ Water Connection Fee TOTAL -Building Inspector Div. Public Works PERlflT*N0. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. J ✓ PAGE 1 MAP d-40. LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK PAGE TONE I SUB DIV. LOT NO. ' LOCATION 73 /,1?e,+vj PURPOSE OF BUILDING &/T BLG f �� -4 OWNER'S NAME �.P e /•fid NO. OF STORIES SI E Ce d/9LR- C OWNER'S ADDRESS ♦� / ��C BASEMENT OR SLABr ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAMEPP� �_. ��pfs,��'�9 SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW No SIZE OF FOOTING X IS BUILDING ADDITION NO MATERIAL OF CHIMNEY IS BUILDING ALTERATION AjU 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 ` ov PAGE 1 FILL OUT SECTIONS t - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELE TRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILLED AND APPROVED BY BUILDING INSPECTOR J+ DATE FILED GO 2 // BOARD OF HEALTH SIG TU F NER�OyR,A OR EDA ENT F E E IU CONTR.TEL# CONTR.LIC.# PLANNING BOARD PERMIT GRANTED BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYFRRIES 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 _ 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE PU TER PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'TAREA _ '/ '/z V. FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARD B 1 2 3 DROP SIDINGN CONCRETE WOOD SHINGLE4 EARTH _ ASPHALT SIDING HARDW'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE ---{I_ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 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 _ FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. STEAM STEEL BMS. 8 COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GASOI L B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING 1 1 PLANNING — � � � ��_ _ i; � Fj 7 �.,;ALu`�r�r� Fi�Vd��L lei . .y t,J d�! ir-.•- a '� s . a.. d' E! 3"3 r F NO R T1y .��,...-�...._vm. 4 ®wn (o 6 OAndoveRo 0 RIVE A"v" EWTF RY PERMIT eye asso A C MEWICK 9 OR P�\ SS BOARD OF HEALTH LJ THIS CERTIFIES THAT............. ... . .. . . ................. .., .. .. ................... BUILDING INSPECTOR has permission to erect ..... buildings on Rough Chimney to be occupied as.... �, ,,,, _ ' Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ION TARTS Rough Service roof iv .... .. .. .. .... .... .. Final • BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises ®� �D FIRE DEPT. Do NRemove emove Burner No Lathing to Be Done Until Inspected and Approved b STREET NO. P PP 1 Smoke Det. Building Inspector N OFFICES OF: F� .•.. ..... oD .I�UW11 of APPEALS NORTH ANDOVER BUILDING CONSERVA'I-ION "" I r VV' I(rN(W Ii t f 71 i 0i -f r, HEALTH PLANNING PLANNING & COMMUNITY UI'sVELUPMEINT KAItEN 1 I.1'. NI:I-SO)N, I)II11:C l c )It In accordance with th provisiotts of MGL c 40, S 54, a condition of Building 1'c11111t Number �� _ is that the debris resulting Irorn this wort; shall he disposed o[ in a properly licensed solid waste disposal lacilily as defined by MGL c 111, S • 150A. The debris will be disposed of in: (Location o[ Facility) Signature of Peturit Al�lili�- -- '9/ Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector.