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HomeMy WebLinkAboutMiscellaneous - 44 CARLTON LANE 4/30/2018 (2) 44 CARLiON LANE 210/1pg,0. -�-0000.0 Date..... .. ............ f. ' &Oii OFTI♦,h o��; ,. �o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �B,�CNUSfa This certifies that ..................0�.................................................... i�-...�. ................................................. 1, has permission to perform ...../�- . ...�'.t. ........;f—^. .. ........1/.. wiring in the building of. ........ .............................................................................. 14LA... a 1 R A..........::....................North Andover Massc w Fee... -......./Lic.Nj. ...31...3�,..'1.... ..... t' ......G........ ... .................. ELtcmicAL INSPECTOR/ Check# i Commonwealth of Massachusetts Official Use Only Permit No. Department ®f Fire Services Occupancy and Fee Checked M BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank 'M APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLE-4SE PRINT ININK OR TYPE-4LL INFORMATION) Date: W City or Town oh 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 e�d J Telephone No. Owner's Address � 4 Is this permit in conjunction with a building permit? Yes E4— 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 Lo�cat�ion and Nature of Propos140 Electrical Wlork: ����,,U 7-[6 wa Cl 1/� �Y6�i'I O pa--e L(/G� ��f°J+i)a�f� at 4/ a � /-ter all Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones 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 Pump N_ umber_T_ans__ 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 SecN.of Systems:* ev ices or Equivalent No.of WaterKW 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 OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. EstimatedValue of lectri al Work: gVfl (When required by municipal policy.) Work to Start: / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C RAGE: 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: INSURIANCE 0" BOND ❑ OTHER ❑ (Specify:) X certify,under it aas s a d penalties o perj ,that the information on this application is true and complete. FIRM NAME: . /P / �G t PC LIC.NO.: `L J 2 U Licensee:�p-calf l� /�f?p/�iy 2 Signature LIC.NO.: (If applicable,a ter"exem t" , the lice se timber line.) Bus.Tel.No.: Address: �? ,Z �� Alt.Tel.No.• *Per M.G. 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 PERMIT FEE:$ ,� v Signature Telephone No, � M ❑ 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 filedr - 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 L 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 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass n Failed Re-Inspection Required($.)❑ f Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: t/v ' Inspectors Signature: v G >' Date: FINAL INS ION: Pass Failed IN Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: ,�� /�_ lzDate: / /3 DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac,com _ _ The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):f Tae- I t"1'"Z Address:—C;/ G 1 City/State/Zip: vt.a?-< 17fl! O?/ Phone#: C/ 2 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/h I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10E Electrical repairs or additions 3.El am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. —z(/ J Policy#or Self-ins.Lia#: W C-0 Expiration Date: / Job Site Address: / �/'7 City/State 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 pains pe alties ofperjury that the information provided above is true and rrect. Sip-nature: Date: Phone it: ' 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#: J � 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the .. dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone 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 Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston.,MA.02111. TO,#617-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-OS Fax#617-727-7749 www mass,gov/dia, 0 r" py.fb�l�Or a�za uo;7e4x3' �', •oN asiraci7 " 9&300 C OP tCILO b-O6�lZ .� 3 Ja1se IGN3 Sj ' I Nt1b .' { _ rlt 4h� 4��jo U01 t s17ati» {Y,e Uilea uucIVLU90k i 1 Fz.Neymh ISSUES HE A6 U,ENP I=TO Alik AV, ria Ota -33b � E, �G 4` Y e YFold Then Detach Along All Pedoiations t: # 09916 Date . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . .4� - ✓D . . , t., f . . . . . . . . . . . . . . . hasyermission to perform . . . . . . . . . .1. . . . A-.1 �... . . . . . . . . . . plumbing in the buildings of. . �: . !����. . . . . . . . . . . . . . . . . . . ,at . . .l. I ��+J ,North Andover, Mass. FeAa�. . . . Lic. No. .M..79 . . . . .Hb. . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check# + b w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK � CITY DATE -. L3 _13 _ PERMIT# t_1 JOBSITE ADDRESS t(Y OWNER'S NAME P. OWNER ADDRESS ---` v�^1 — --— -- —-- _ TEL 8 � �_ 1 S 4 1 F S. TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:[Q REPLACEMENT:R' PLANS SUBMITTED: YES NO( FIXTURES Z FLOOR- OBIM 1 2 3 4 5 6 7 8 S 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE I__DEDICATED SPECIAL WASTE SYSTEMDEDICATED GASIOIUSA14D SYSTEM — DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ' _-_ __-- _ _— --._-• _ __._._-! .-- —� DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _.._-= ._.___ -- .----- ------- FOOD .----FOOD DISPOSER FLOORIAREADRAIN INTERCEPTOR INTERIOR KITCHEN SINK ___! --} 1 _.._.I _I — •_--! _-- __. _I ___J _..._J --.__I .__-- - -- J _--! M LAVATORY E-711= __- ROOF DRAIN E—_.. ! SHOWER STALL SERVICE!MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING '. _.--- OTHER .._-__------------------------ -- --� ---- -- - - ---- — INSURANCE COVERAGE: I have a current 1 abilit insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YESM NO [ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE OF INDEMNITY Q BOND 0 OWNER'S INSURANCE WAIVER:I am awarethatthe licensee does not havethe 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 0 AGENT .__i 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 vri!i be in co (lance with I( ertinsnt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _ _._Q .x_. _- - t .- r-_--____i LICENSE# _� .3. .- _ IGNATURE MP z] JP[]_i CORPORATION[# PARTNERSHIP OW LLC El# COMPANY NAME --- -- - CITY �JSP— -—__ -STATES' �[ZIP TEL FAX CELL _ EMAIL C.0.. - YY1. - .ADYq — ----- -a �/ -7e� The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):alejandro aguilar Address:44 carleton st City/State/Zip:revere ma 02151 Phone 4:6179132194 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 employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑✓ 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. employees and have workers' [No workers' comp.insurance comp.insurance. $ 9. F] Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no 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 a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:44 carltonln City/State/Zip:n andover 01845 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of 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 hereb ceriffy under the a' nd enalties ofperjury that the information provided above is true and correct. Si nature: Date /23/13 Phone#:61791321 J4 Official use only. Do not write in this area,to be completed by city or town offwiaL 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#: Division of Professional Licensure: License Search Page I of I The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency More... LICENSEE Name:ALEJANDRO D. AGUILAR REFERENCES& REVERE,MA RELATED INFO A i Disclaimer Regarding **This Licensee has additional Licenses,click here to view them.** Website License Searches Enforcement Process Glossary Licensing Board: PLUMBERS Et GASFITTERS Glossary of License Status License Type: MASTER PLUMBER Codes License Number: 15329 More... Status: CURRENT Expiration Date: 5/112014 Issue Date: 10/23/2007 Exam Date: 10/23/2007 School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday,April 29,2013 at 2:41:33 PM. 0 2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http:Hlicense.reg.state.ma.us/pubLic/pubLicenseQ.asp?board—code�--PL&type—class=—M&I... 4/29/2013 Date.&/v//l.. .. ..... ,1°R7M TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION b�s34 c.HuSE�t This certifies that . . . . . . . . "• •�' . . . . . . . . . . . has permission for gas installation . U?�. . . . f. . . . . . . . . .. . . in the buildings of . R'� . . .f� Z 7.�4/�-- . . . . . . . . . . .. . . . . . �. . f . . . at .�� .� 9`/r,Z. . . . . .g� ,,Nor�lrndov�, Mass. Fee. ,�U Lic. No.. 7.T. . . . . GASINSPECTOR a Check# 7974 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:/Y• 1ikle; ©6672 MA. Date: 102 Permit# Building Location; Le / /✓ ZAI Owners Name: 4/YDS,!� Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional❑ Residential New:J4 Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES ui LU Z FLU - N U H ro Lu O = N to z 1— OF z J } Lu Z 0.' W Q H 7 � W � g W CO w m 0 Q a 1W- o w x ' N > w z cn 0 F- W co 0 a W _ L � 1- 0 0 w w w z M W S w I— o > 0 W Z O H I- 0 z c7 LL w t— w W Z w } fn Q Q m W O Z O O a W W Q > O O w z z w a U o O u_ 0 0 z x —j O a E- > > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR ` 3 FLOOR 4 FLOOR 4 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: h4 orporation Address: t- City/Town: G Stater El Partnership Business Tel: Z24ff -5xJ'!�S Fa . ❑ Name of Licensed Plumber/Gas Fitter: Firm/Company D INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy a-- ` Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;1 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 ompliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: ❑ Plumber ❑Gas Fitter Sig ture of License Plu ber/Gas Fitter Master ,, i/j \,own Journeyman License Number:/// � 40VED OFFICE USE ONLY ❑LP Installer 1 / aa1c2-6 3 44 Com.- /K: 5� e q r The Commonwealth ofMassachusetts Department oflndustlrialAccide>is Office Oflnvestigations 600 Washington Street sv Boston,MA 02.111 Workers' Compensation Insurance A.ffid��.gam tiers/ContractorslElectricians ovIdia A licant Information /Plumbers please Print Legibly Name(Business/Organizationlfndividual): Address: o .City/State/Zip: •�� ' --(�,,.�� �� Phone#: �- �ZJ%'�9�ss Are you an employer?Check the appropriate box: 1�I am a employer with , 4, general Type of project(required): employees(full and/orpar�part-time).* ❑have hired the sub-contractors ontractor and f 2.❑I am a sole proprietor or partner listed on the attached sheget. 7. ❑Remodeling construction Ship and have no employees These sub-contractors have working for me in any capacity. workers'comp,insurance. 8' ❑Demolifion [No workers'comp.insurance 5. ❑ We are a corporation and its 9- ❑Building addition required.] .officers have exercised their 10•❑Electrical repairs or additions 3.❑I am a homeowner doing all work right of exemption per MGL 11Iumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no insurance required.]t employees. 12❑Roofrepairs [No workers comp,ins urancerequired.] 13.❑Other E. applicant that checks box#1 must also fill out the section below showing their workers'compensationpolicy information. 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.Poliaffidavit inin sting inn uc g lam an employeY that isproviding workers'compensation insurancefor my employees Below is tkepolicy and job site information. �_ Insurance Company Name: Ya do/c p S Policy#or Self--ins.Lic.#: Expiration Date: Job Site Address:_ �� c�'/ � Z/"/ City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).� Failure to secure coverage as required under Section 25A ofMGL c.152 can lead to the imposition of criminalpenalties o£a fine up to$1,500.00 and/or one-year imprisonment,as wellas civil penalties in the fomt of STOP WORK ORDER and a of up to$250.00 a day against the violator. Be' that a copy of this statement may be forwarded to the Office a fine Investigations of the D9 for insurance coverage verification. I'do Izereby certify nder f e pains antl penalties ofperjury that the information ptoviderl above is true and correct. ` ii nature: Date: %0110#: Official use only. Do not Write zn this area,to be coinpleted by cify or town off cial City or Town: Issuing Authority(circle one): Permit/License# I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5Plumbing Ins 6.Other . Inspector p Contactperson: ' .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 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 insuraned coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers;compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)andphone number(s)along with their 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,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should 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 Iaw 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, PIease 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 pernutilicense 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 marred 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 or permit to bum leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone.and fax number. Tie Col-U.w.OrAwealth of M ssachwetts Depaetruent of hidustrial Accidents Office of Investigatlons 600 Washington Street Boston.;MA 02111 Tel.#61.7-7274900 ext 4406 or 1..877-M SS.AFE Revised 5-26-05 Fax#617-727-7749 WWw.mas&Aovfdia. III �y S December 20,2011 Dear Mr. Inspector, We are requesting a permit so that Demers Plumbing can run a natural gas line to our kitchen and connect a new gas oven and range. After initial inspection it came to our attention that there was not proper clearance for the microwave oven and adjacent wood cabinets. These have been removed (please see photos below),and we have hired a cabinet professional(Joe DeVelis-JD Home Remodeling) to replace these units with ones that are within the current codes and regulations. It is our hope to have this oven and range installed immediately so that we have a functioning kitchen for the upcoming Christmas holiday. Thank you in advance for your immediate attention to this matter. Sincerely, ndy lodk 44 Carlfon Lane North Andover,MA 01845 Before After Y Date.0/z. . .... .. pORTiq pf ,.to ,ti0 o� TOWN OF NORTH ANDOVER 09 PERMIT FOR GAS INSTALLATION ' •� SSAGHUSE��y This certifies that . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . .0 .1171(.. . . . . . . . . . . . . . .. . . in the buildings of . . . ��!2 -. . . . . . . . . . . . . . . . . .. . . . . . at . .'' . .L.fir. . .. . . . , North Andover, Mass. Fee.2�. Lic. No.!�.`Y� Y.z . . .. . . . . . GASINSPECTOR Check# G" 2 7 7'1 l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: _0M -4-6odIt Date: ' /- l0 _ Permit#. Building Locatic _ T uy�/f A/ 4N` Owners Name: le,6r j Typo of Occupancy: COMMerclal Educational Indust InstitutionO Residential New: Alteration: Renovation. Replacement: V Plans Submitted: Yes No, FIXTURES a W IW�— Y = 6: W W O N H O 0 ~ I SI Z AFW- I zI ( .,� tYl 0 ~I I i W 'o W in 0 a 1— C G x it Z W a�C N J ~ ~ m w O z 0 M- H W FW- LU I-- W v o 0 = i g o a o� z > > > 3 0 SUB BSMT. BASEMENT 15T FLOOR 2 FLOOR 3 FLOOR im FLOOR 7i-FLOOR Y i'm FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# installing Company nafie: V( Corporation �nil�j,'S LG f Address:, ,a, _ - State: Mk_l3aX_Gf. CltyITown:, jJ�/ ,y� ,� Partnership Business Tel: 97�6g3.p?j'y� Fax: 6 jWfS 7,7py Finn/Company Name of Licensed Plumber/Gas Fitter: 611/ INSURANCE COVERAGE: - have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes M No.. If you have checked Yes•please indipate the type of coverage by checking the appropriate box below. A liability insurance policy _ Other type of Indemnity Bond OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner : Agent Signature of Owner or Owners Agent By checking this box❑;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 compliance with all Pertinent provision of the Massachusetts State Plumbing Cale and Chapter 142 of the General Laws. yype of License: BY __ �/.Plumber Title' ✓ Gas Fitter Signature of Licensed Plumber/Gas Ffter - Master City/Town. _ _ . __._ Journeyman License Number: APPROVED OFFICE USE ONLY) LP Installer Date.,4�f!��. "oRTM TOWN OF NORTH ANDOVER 146 PERMIT FOR PLUMBING :7 SSACHUS� This certifies that . . . j. . . . . . . . . . . . . . . . has permission to perform . . . . 7. . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . r. .-N A '4. . . . . . . . . . . . . . . . . . . . at. . . .... . . . . . . . . ., North Andover, Mass. Fee. .3v r. .Lic. No.. Y. `4 L . . . . . . . . . . . Wit. . . . . . . PLMBING INSPECTOR Check # '36 2 7 8471 I.:�L) MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING CitylTo;fsii: 4ART,Y Ali MA. Date: '�� 6 Pellrit# �1 7 � - C� URR Building Location: &Y ��/Y L� Owners Name:_19s61f1fr Type of Occupancy: Commercial❑ Educational ❑ Industrial❑ Institutional❑ Residential B New:❑ Alteration:❑ Renovation: ❑ Replacement:^< Plans Submitted: Yes❑ No FIXTURES cn I I I I ° � u Z N a z ~ YUZI 1 0 y Q a y Z ° 9 M Z 3 s W a. w. rn } w z cc Y co o a x 0 c W ° S c z fr n g z LOU rn O v a LL Lj Ia _ g g IQ— 3 $ 3 0 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR „ Vu FLOOR 4 FLOOR 8 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: j2' f 6 H16L SlIeOne Only Certificate# KI Is/corporation Q?z Y'7 C Address: ()r D Cityrrown "(�J�,AN 11AM9 State:if ❑ q Partnership Business Tel: /7K ('K.3 9 756 Fax: 6 0.3 a 93 �?Y Y Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes;please Indicate the type of coverage by checking the appropriate pox below. A liability insurance policy 19 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: i Title ❑Plumber Signature of Licensed Plumber Cityfrown ❑Master License Number: APPROVED OFFICE USE ONLY ❑Joumeyman Location No. J6 A Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ *Also• Building/Frame Permit Fee $ S PUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ CO Check # 18465 -Building2-11 Inspeolf5f TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIJ RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r sss .� iu BUILDING PERMIT NUMBER: �Q DATE ISSUED: m SIGNATURE: -'I Building CommissionedI or Mldings Date Z SECTION 1-SITE INFORMATION O 1.1 Property d 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided r 1.7 Water SnpplylvCG:L.C.40. 54r^';: 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0— Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 aaaal J SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT Historic IS CIC : Yes NO m 2.1 0wne-of Rfcord Na,nn,,,Z Address for Service 72- 931-7j�- Signatu Telephone 2.2 O er RecPord: p Name Pit Address for Service: z _ A. � m Si nftre Telephone 90 SECTI 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number on Address D ic Expiration Date Signature Telephone r a` 3.2 Regist - Home Im veme Contractor Not Applicable 0 sQ Company Name 't'L M au/o�� - R gisiration Number r Addre n � {{{���/// D r ���`t Expiration Z Si natur Tel hone SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result s in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work check all a livable New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition 0 Other 0 Specify Brief Description of-Proposed Work + t SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OILIALVSE OlNLY Completed by permit applicant 1. Building (a)'Building Permit FeeF Multi ljer 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC CO-0 5 Fire Protection rn 1 .74 6 Total 1+2+3+4+5 w Check Number SECTION 7a OWNER AUTHORIZAT N TO BE COMPLETED WHEN OWNERS ENT OR CONTRACTOR APPLIWS FOR WILDING PE T Own r/Authorized Agent o subject property Here rize et on M ehalf,i 11 ma S 1 iveto work authorized by this building permit application. kr i r Are r Date �%TIO 7b OWNER/AUTHORIZED AGENT DECLARATION I, As Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Aent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS ]ST 2ND 3 SPAN DIMENSIONS OF SMLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEfGHT OF FOUNDATION THICKNESS SIZE OF FOOTING ,X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND 1S BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of t 4Andover /off .. "A No. _ dNo LA over, Mass., 97WO443 I� COCMICKEWICK 7�ADRATED '9S BOARD OF HEALTH M 'LTPER D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT ..a..................................................................... ............................................... Foundation has permission to erect........................................ buildings on.... ....... Rough to be occupied as Chimney ... ... ... .. .. . . ................................................................................................................................. provided that the person acce ng his permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisi s of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION T - ELECTRICAL INSPECTOR Rough .....................................a.....................-15 Service ....................................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. + SEE REVERSE SIDE Smoke Det. ^ � � � ✓� "(7097fi77Zd12[l/BQ�L/L O�✓��{L6C�6 � , - Board of Building Regulations and Standards ! lfHOME IMPROVEMENT CONTRACTOR Registration: 108424 Expiration:_ 8!1.812007 ti Type ©BA ABCO ROOFING A\ON &RUC1TION Joseph Gys 10 MEGHANN LANE"~ „- rju✓ LOWELL,MA 01852 Administrator NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance 'th pro 'sion of MGL c 40 S 54, a condition of Building Permit at: that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cIt, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: .o &Gm ation of Facili O' s"46e Permit Applicant Fire Department Sign off: Dumpster Permit Date { r Page No. of Pages �ABCO ROOFING & CONSTRUCTION CO. PROPOSAL AND LOWELL, MA 01852 ACCEPTANCE 978-937-5840 or 978-957-8212 PROPOSAL SUBMITTED TO ..= PHONE DATE STREET JOB NAME is r x CITY, STATE AND ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: / II ( i t V Jy y1 ;T,%' t, (c tr�.'r 64 Yka rl / f 0 We Pro Se hereby to furnish ma7rior and labor — complete in accordance with above specifications, for the sum of: e f- U-, r . � (;u eel G Payment to tici,made ,as follows: . dollars (E 2L6/10 , •/ ilr r r� All material is guaranteed to be as specified. All work to be completed in a workman. �+ like manner according to standard practices. Any alteration or deviation from above Authorized !r specifications involving extra costs will be executed only upon written orders, and Signature will become on extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to Corry fire, tornado / and other necessary insurance. Our workers are full covered Note: T is,pro as al may be pensation Insurance. y by Workman's Com• withdrawn lly us i not accepted within days. Acceptame of Proposal -The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signotur Dote of Acceptance Signature r. Page No. of Pages '.ABCO ROOFING & CONSTRUCTION CO. PROPOSAL AND LOWELL, MA 01852 ACCEPTANCE 978-937-5840 or 978-957-8212 PROPOSAL SUBMITTED TO ' 1 PHONE DATE I/ n STREET / JOB NAME CITY, ST 'TE%AND P;CODE JOB LOCATION ' t I_ ARCHITECT DATE OF PLANS JOB PHONE We hereby,1submit specifications and estimates for: off (0 tlot 9, 4 oft +•_., /�•' t /;.� f /� V� L�C.�".-} / � 1�'� f 1,/'�" <',�..��� / jw We Propose hereby to f6rnish material and labor — co ete in accordance with above specifications, for the sum of: (S ). Payment to be mode as follows: dollars All material is guaranteed to be as specified. All work to be completed in o workman- like manner according to standard practices. Any alteration or deviation from above Authorized specifications involving extra costs will be executed only upon written orders, and Signature will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado Note: This proposal may be and other necesaory insurance. Our workers are fully covered by Workmen's Com- withdrawn b us if not accepted within days. pensotion Insurance. y P y F ce of Proposal -The above prices, specifications s are satisfactory and are hereby accepted. You are authorized rk as specified. Payment will be mode as ootlined above. Signatueptance Signature N2 2197 Date. ... . - d.......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING fl lo This certifies that ..... . .......... ................... ""'T""................. has permission to perform .................................. ............ ...................... wiringin the building of.................................................................................... .......... ........ ...................... .North Andover,Mass. Fee!9'2.............. Lic.No?./.... . ............. ........................ /11� - ELECTRICAL INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer T1EC0MM0NWE4LTH0FM4Ma7IM = Office Use only DEPARTMOVTOFPUB1dCS MY Permit No. CP2/71 BOARD 0FMEPREVEW0NRE9X4TI0 S527CMR12.00 � 1 Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work describers below. Location(Street&Number) "f t cj� ,J ,, Owner or Tenant /�'1r, E5,Fe-1- Owner's Address S 6`"1 Is this permit in conjunction with a building permit: / Yes ONo (Check Appropriate Box) Purpose of Building Sr!�f� t q�u t(�+ �G��1� Utility Authorization No. Existing Service Amps/ Volts Overhead Underground No.of Meters New Service Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No,of Transformers Total KVA No.of Lighting Fixtures © Swimming Pool Above Below Generators KVA and ground No.of Receptacle Outlets /D No.of Oil Bumers No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges / No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW initiating Devices No,of Dishwashers Space Area Heating KW No.of Sounding Devices t No.of Self Contained I Detection/Sounding Devices N,p.of Dryers / Heating Devices KW Local a Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER - InsuartlxCtaatgz Purst>artacthetagtmanaresoflvta�dts>�C�atealLaws Ihneata$atLiabileyhmm=PcbcymchdTCrnqtOpa�CoArdWats,ghtttWa*ivalat YES 0 NO IhmstJrrtiRidvafidpto0ffofsar=1DdeOfoe YES U NO If}Doha%,cdmiwdYFS,pleaseadtal fttAxofca&alpbydeckrgthe Il�StJRAT� M,--BOND r7 OMM r7 ftweSPa*) E#abauDae ! C,+(( Esftml*dVArdE10Mi 3IWcdc$ WakIDStNt �— Ir CtiauD�leRat dad RarglrFrd *nedunrsa RMaiMcfPeduay p� ( C I° LioatseNa ��3 7 Z FINAME c t c or RM Lirm= 1-�AJ ��l� Lina�eNo -P f( Bus¢uassTd.Na ��/ �YS7 Addre Cc�(�,s r� i,>,tA-, AiTel.Na .J 7S `1o77 OWNER'SMJRANCEWAIVER,IamawarethanheliomsedomnQ,t_tt etteinsimma►eV AsstksmWegtivalatasm mafby CataalLaws aodthatmys�atuemtiasparrttapp5r�u0ttwai%�ttnsregtmsrre:tt.. (Please check one) Owner a Agent ID Telephone No. PERMIT FEE$ �� 4 Location ``L/ No. Date `� w NO�TN TOWN OF NORTH ANDOVER ?O:�•.•o ,•�h.O Certificate of Occupancy $ cNust< Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # .31 ,. 13663 l f Building Insp,6tor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a p BUILDING PERMIT NUMBER: ®7 Al DATE ISSUED. /.2.5-/6 O SIGNATURE: /tuilding Commissioner/I for of Buildings Date n SECTION -SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Amber Parcel Number e 1.3 Zoning Information: v v I 1.4 Property Dimensions: v Zoning District Pr osed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided —Required Provided 1.7 Water Supply M.G.L.C.440). 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name Ant) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 7. M Signature Tel hone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ .Licensed Construction Supervisor: �D 0 //�� �;r�T �CG License Number 7 r Address �7y 3" Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address /0 Expiration Date R A Signature Telephone G) SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6). Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) Ve Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: t � � SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFkCICAL }Nl Completed by permit applicant N 1. Building (a) Building Permit Fee �� QQ Multiplier 2 Electrical (b) Estimated Total Cost of �/ Qa Construction 3 Plumbing -ew Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 � /SQ Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building penmit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION /—EQ//�" as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name P Signature of Owner/A 9ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TUABERS 1 2ND 3 SPAN DEVIENSIONS OF SILLS DIMENSIONS'OF POSTS DUVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOa4 X MATERIAL O 'CI-IIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I b l( b DEPARTMENT OF PUB_?C SAFETY 167258 ONE ASHG ` ON PLACE:, RM 1301 BOST '1 02108-1616 CONSTRUCTION SUPERVISOR LICENSE Number: Expires: a _ CS 004613 03/19/2000 :T- Restricted To: 00 DENIS P BOUCHER 145 STEDMAN ST -#3 CHELMSFORD, -MA 01824 Keep top for receipt and change �' �' �° of address notificat.iOn. ------------------ --------------- ---- ---- - ----- Alte rd of Building Regulations and Standards i One Ashburton place - Room 1301 Boston , Massachusetts 02108 Home Improvement Contractor Registration Registration: 114800 Expiration: 10/26/01 Type: Individual OHE IMPROVEMENT CONTRACTOR Registration 114800 DENIS BOUCHER CONSTRUCTION + .*Expiration: 10/26/01 RENIS E30UGHER Type: Individual 145 STEDMAN ST . #3 OUCHE CHELMSF=ORD MA 01824 DENIS BCONSTRUCTION RENIS BOUCHER WTEOMAN ST. 13 ADMINISTRATOR CHELMSFORD HA 01824 BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with,the provisions of.MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11,S 150A The debris will be disposed of in: Location of Facility - Signature of Permit Applicant . Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector M � 1 • w Tl e Commonwealth of lvlassac,�usetis Department of Industrra"cc;dents Gffice of Investications Boston, Mass. 0211 i ^ •.`� "u ✓Vcrkerc' Com,pi n.zaricn lrI c:irCE, i iGc'/ii Flame �1�✓�� ` G�i1�' �-%j Please r=r!nt C Lnc=ticn' �/ �J J Ciel Phcne I am a hcmecwrer p-eFic�T7 inc all work myself. am a scle crcprie!cr and have no cne wcr<ine in any cacac, y �II am an emcicver:rovidine wcrkers' ccmpensaticn rcr my empicyees''vcr'<inc cn this jcb. Comc2mi name: Address Cihr =hcre�`• InsurancE Cc Pciici I Comcanv name- Address Chcre 1. Insurance Cc. F^lice Failure to secure ccverace as reccire^_uncer 5�':ten 25A or VC-L 152 c-in iecc:e the;mcc:siiicn or cnrrir.ai penalties or a rine up to S1,5c0.c0 ane.'cr one years';mcrscrmert as .ve:!ss c:v i Penalties in the rcrm or a S-CP WCRK CRCFF.arc a:ine or; NORTH Town of Andover TITLaW No. PRO a dover, Mass., 'AA COCMICMEWICK\� DRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �� M BUILDING INSPECTOR THISCERTIFIES THAT..........DArOVIA............ �.... .... ............................. ... ........... .... ........ Foundation has permission to erect.... ..... ...... buildings on.......4 ... �A� Rough ;..................... .............................. . �� �� 'N ... Chimney to be occupied as....................... ........... .. ............................................................................ .............. 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 C PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR p UNLESS CONSTRUCTI TS Rough .. .... ................ .... ............... Service 600W BUI G INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final T No Lathing or Dry Wall I o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner J Street No. SEE REVERSE SIDE Smoke Det. NORTH omm OX Over "A . No. _ _ _fir_` � o '� dover, Mass., 42 COCMICMEWICK V ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �� BUILDING INSPECTOR THIS CERTIFIES THAT..........�.��I.�...........�?.40.40.. .... ............................. ... ..................... .... ........ Foundation has permission to erect.... M..... ...... buildings on ...... ... / xo. Rough to be occupied as........................ ...........�,.. N...........'~................ . �S I �F 44C ie. 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 V& ew PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI TS ELECTRICAL INSPECTOR Rough ........ .. .................... .... Service Now BUI G INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on Wall Premises — Do Not Remove Final No Lathing or Dry YYall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location No. Z1 Date 7 t NOR, - TOWN OF NORTH ANDOVER Aill"kiblit �, Certificate of Occupancy $ }^ ; Building/Frame Permit Fee $ Foundation Permit Fee $ S kMUSt Other Permit Fekg- $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ f Building Inspector Palitii . a J 15.00 PAID - 8567 Div. Public Works PERMIT NO. Z� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE SUB DIV. LOT NO. LOCATION p I•� ) PURPOSE OF BUILDING 1G..ls 1 C_.3 t j OWNER'S NAMEO/1,, �//.._.� NO. OF STORIES �� SIZE iOW NER'S ADDRESS/ / (/,1/",__ !l_�fC�•�!/�/ ��n BASEMENT OR SLAB ARCHITECT'S NAME I SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OFISILLS -- DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION �� THICKNESS,- IS BUILDING NEW SIZE OF FOOTING 19 BUILDING ADDITION MATERIAL OF CHIMNEY •�'��'� IS BUILDING ALTERATION 1/ /p�/ t. IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODES 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 jay©6�?® PAGE I FILL OUT SECTIONS 1 - 3 EST. BLDG. COS PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COBT 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 — .L.! � 1... fU1LDIN0INfPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT . F E E OWNER TEL.# f PERMIT GRANTED CONTR.TEL A'08�" / / Z I9 CONTR.LIC.J! /®® / H.I.C.# V �z�? BUILDING RECORD t OCCUPANCY 12 SINGLE FAMILY S-ORIES 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. t CONSTRUCTIO 2 FOUNDATI I 8 NTERIOR FINISH + CONCRETE JII d t 1 I3 CONCRETE BIL K. BRICK OR STONE RDW D PIERSASTER iTY WALL U IN. 3 BASEMENT AREA FULL FIN. BM AREA ATTIC A-Tt A NO B M T FIRE PLACES HEAD ROOM _ MODERN KITCHEN _ O" 4 WALLS I 9 FLOORS o CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ 0 l� WOOD SHINGLES EARTH ASPHALT SIDING HARDIN 0 J// ASBESTOS SIDING COM/dCN �,� lld�s� 1:2 VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME �,s✓j �Q BRICK ON MASONRY ATTIC STRS.&FLOOR BRICK ON FRAME CONC.O INDER BLK. STONE ON SONRY WIRING STONE ON FRAVE UPERIO POOR ADEO ATE I� NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBREL MANSAR TOILET RM. (2 FIX.( FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL ALL SHOWER _ ROLL ROOFIN MDERN FIXTURES _ TILE FLOOR TILE DADO i 6 FRAMING I i t 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 GAS 7 NO. OF ROOMS pIL B•M'T2nd _ ELECTRIC 1st 13rd NO HEATING ORT own of over No. 327 yy ass.,�[Uk4 Lk 19 C' 1 rt dover, M qs' 0 LAKE COGHICHEWICH rED P\ BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System W__ BUILDING INSPECTOR THIS CERTIFIES THAT...MPA....RU.....ft.ec.(..................................................................................................... ......... ........ . Foundation has permission to erect ..>.ftl *:.:�.................... buildings on JK.....Cxe'.6t4....1--&**......................... Rough tobe occupied as...k.+C.L:;V...... .......I......................................................................................................... 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 Final PERMIT EXP M 6 MONTHS ELECTRICAL INSPECTOR UNLESS CON TR r T Rough .. ..... ........... .......... .................................. Service BUILDING P OR Final ina 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 (el \ �r q�; :V�'.� 3:'�`dt�►i'tlflBtZrn',fL 4�•�i.i��(•CL'JGGG^fCIIGP.��d HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards On:: Ashburton .Place = Room 1301 � Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 114800 Expiration 10/26/95 Type - INDIVIDUAL DENIS P BOUCHER " DENIS P. BOUCHER 132 TYNGSBORO RD #14 N CHELMSFORD MA- 01863 + x COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY 9 OF ONE ASHBORTAN PLACE �AstMpsllf �ftWB�ril MASSACHUSETTS BOSTON,IAA 02108 Ords/soarsstorr00atlOs EXPIRATION DATE 0*3/1'=x/1.9c"116 CON:.;TR. S1.j •&',V T Z;t_ih CAUTION RESTRICTIONS EFFECTIVE DATE UC-No. FOR PROTECTION AGAINST THEFT,PUT RIGHT THUMB NONE �� g c:if,/=:;t)/1`=)'=�.` iJi:)-'E;=,a:_; g PRINT IN APPROPRIATE I BOX ON LICENSE. I.!t;_1-1 ER BLASTING OPERATORS If 025 �f= f f;C1�1D MUSTPHOTO 66DE P R.. orun FEE - !_M 1=t�iriC1 I`"f-1 t]1 .' 4 J I PHOTO. ,,._ NOT VALID UNTIL SWNED BY LICENSEE AND OFFICNLLY HEIGHT: STAMPED-OR•SIONATUREOFTHE COMMISSIONER Nuu 2 DOB: o9tC �1�� .�. THIS DOCUMENT MUST BE SIGNY/ CARR EDONTHEPENSON OF SIGNATURE OF LICENSEE' NAM ABD IATURE UNE THE MOLDER WHEN EN- •NT GAGEDINTIASOCCUPATION. R FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 4x, clb� Phone b LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street Z- St. Number ************************Official Use Only************************ ,17O ATION OF WN S: Date Approved 1,) Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspecto�- r-Health Date Rejected � � Date Approved 7 �� Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date 9 LOT 24 LOT r AREA= 45,636±SF 23 SCREENED PORCH r � dj alp c` _ N, 21/2 $TY # 44 DRAINAGE EASEMENT DRIVE � UTILITY EASEMENT �\s232' 17" 33 133.63 L=107.64' _ I OF Atq g. CARLTON Z-".e o JOHNA. u� o HA NON N0.36380 9 FES510�y0, >►� un THE LO ATION OF PROPERTY LINES SHOWN HEREON IS BASED ON PLANS BY OTHERS AND ON INFORMATION FROM VARIOUS SOURCES AND IS TO BE USED FOR MORTGAGE PURPOSES ONLY AND NOT FOR ESTABUSHING LOT LINES, LOCATION OF FENCES, DRIVEWAYS ETC. AN INSTRUMENT SURVEY HAS NOT BEEN PERFORMED. AN INSTRUMENT SURVEY IS ADVISABLE IF STRUCTURES ARE LOCATED WITHIN ONE FOOT OF A LOT UNE OR ZONING SETBACK UNE. CAMERON—BISHOP ENGINEERING CORP 90 MONTVALE AVE, STONEHAM 02180 (-7)zn-cu DASD JOB • e�o..�+csx .�. I60 rr eoat /53 FADE PLAN+ 67Z 19083 " L Al o Nh Mdaj'�-,,t69 C nQ P. ANO DQE wsmoM BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF, I CERTIFY THAT; — THE BUILDING CONFORMS TO THE FRONT, SIDE AND REAR YARD SETBACK REQUIREMENTS AND THE LOT CONFORMS TO THE AREA AND FRONTAGE REQUIREMENTS OF THE ZONING BY—LAWS OF THE TOWN OF AgX4 R+vow�,Q. WHICH WERE IN EFFECT AT THE TIME OF CONSTRUCTION. ll i — THE STRUCTURE ISiVai IN THE SPECIAL FLOOD HAZARD AREA AS SHOWN ON THE F.I.R.M. DATED:(a�(rl/ �3 ' �►+m, �Anr�L iva . Z 5oor18-./0 6 fffff) _ o pl- '?s c.•:-7"f�/ �l,7'�r�L'? 'jJ ✓l ill'�� -�'�/%t. j • 1,q t 1-717 T�