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Home My WebLink AboutMiscellaneous - 44 EMPIRE DRIVE 4/30/2018 ,v 1 V �_ 76 . 0 Date..3 �.�,/.! ........ NORTH °f ...o ,s'14° o� TOWN OF NORTH ANDOVER F ,. 9 • PERMIT FOR GAS INSTALLATION s o� .'�• . 9 SACMUSEt4 L Lf "�, This certifies that . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . .n ` ` . . �.C. in the buildings of . . . , 6 n c at . . . . .. . . . . :/'� . . .`. . . . . . . . . . . . . . .�, Norah Andover, Mass. Fee. Lic. No..'.' `. . . -:. . . . . .. . GAS INSPECTOR Check# Y �Y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: 040414- Pk-t/k-Xf , MA. Date: 3 ` l 6'I Permit# ,, Building Location: LN (,,' A 4/11vL a (1„ Owners Name: 6�ftz* " V 4 i.�.f1*0&t-tc Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional❑ Residential N) New:'CiP Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No❑ FIXTURES rr W UJ U) z H U = m = O W U ~ in OO uuii X t- Z H Q Z W j W 0 F- D N w W w IM 0 Q a o W w X U) U z N O Q W v) O w o o = W � W Q W W W z W w = W 1- z W W > t) W Z a J f— F- O z J 0 W � W H W W U o o LL O U' i W n > O Q O W z z W a F- o a W W ►- > > > 3 0 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 51HFLOOR 61HFLOOR 71H FLOOR 81HFLOOR Check One Only Certificate# Installing Company Name: GAUD A50 PL1r1Qtky., '& iicATiNG &(Corporation 3196 Address: P.O. 60K I)Oil City/Town: NAQEV-I*!`I_i_ State:-M-4 . ❑Partnership Business Tel: q,7j-37y- I'7y3 Fax: Ot- St2!-44131 ❑Firm/Company Name of Licensed Plumber/Gas Fitter: ST E P H C-0 . GALS losKH INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes 95'No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy [✓r 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❑;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. Type of License: � (,I By ['lumber C, J11- Title ❑Gas Fitter Signature of L ensed Plumber/Gas Fitter YMaster City/Town ❑Journeyman License Number: 10114% APPROVED OFFICE USE ONLY ❑ LP Installer FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAME&TYPE QF B SIL nn rn LOCATION OF BUILDING . SKETCH PLUMBER, ASFLTTE LP INSTALLER LICENSE NUMBER: PERMIT GRANTED DATE: GAS FITTING INSPECTIOR 88u5 Date. .3��.'. . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACHUS� � This certifies that . .�lf `��:.`. ./:.. . . . . /I/. . . . . . . . . . . . . . . . . . . has permission to perform . . . ,1L. . . plumbing in the buildings of C , , ..,, . . . . . . . . . . . . at . . . ;. . ., North Andover, Mass. Fee. .L/d .Z. .Lic. No..1.L.% .`� ! . ::. Y PLUMBING INSP CTOR Check # /-7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:U"WfWA-„``Wd0,..i( MA. Date: 3 Permit# Building Location: q ( 1%V"N'P 1L4— Ott Owners Name: Type of Occupancy: Commercial ❑ Educational❑ Industrial ❑ Institutional❑ Residential' ' New: Alteration: ❑ Renovation: ❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED Z SYSTEMS LU z t— O '^ W Y u Wz N H x H Ln 0 d' of Z 1- Y Q of J� Q W C7 z OC z d W Z Z d' H Z Q h Z n N CA W a 3 WA x %n Q �, Q in '^ o a le X Q Q m < W o m m z n Z u a = = Q 3 0 3 OG Q W W h LU J Q C C 0 W W Y W y H W u H N d 0F > > CI O Z H O ? Q Q Q x v1 W Q X Q Q J Q Q O x J Q °C F V Q a[ Q a m m a o LL SUB BSMT. ~' ,BASEMENT 1'FLOOR ( I 1 ,f 2ND FLOOR Z 2 V FLOOR 4'FLOOR FLOOR FLOOR 7'"FLOOR FLOOR Check One Only Certificate# Installing Company Name: GA L1 MSKY PL0M 3i iyC, 4 i{CAT IAJ Corporation 3101(o Address: P•0, WX 1701 City/Town: NAUER1ULL State: MA, Business Tel: q7t- 37'4- 17103 Fax: Q79'Sal-z41 SI ❑Firm/Company Name of Licensed Plumber: STEPitet. C. DIAL S NSK�( 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 Q" 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 Signature of Owner or Owner's Agent Owner El Agent F] I hereby certify that all of the details and information 1 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: )J7 Cc Titlev[f Plumber Signature of Licensed Plumber City/Tovun [a' Master APPROVED(OFFICE USE ONLY [:]journeyman License Number: 10341 i FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) i FEE: $ PERMIT# i APPLICATION FOR PERMIT TO DO PLUMBING I i I NAME&TYPE OF BUILDIN i I i LOCATION OF BUILDING SKETCH i I I i PLUMBER I I I I f LICENSE NUMBER: I i i I PERMIT GRANTED F� DATE: I I I i I i PLUMBING INSPECTIOR i I R 9766 Date. �......�...... . . ... .. Y NORTH °ft`s`°;•'"° TOWN OF NORTH ANDOVER o . p PERMIT FOR WIRING ;,sSACNUs� This certifies that .........r�.......ep........... �''.`!...�../......................................... has permission to perform ..... wiring in the building of .................. at.��..f'... v...'.`=`1.�.�1......C�;;1 �.� ... e4l4orth Andover,Mass. Y Fee.3.5.I...��6 Lic.No!!..Cf U................. .............. ........ . . . .: .. q •ELECTRICAL INSPECTOR �.. Check # ;46-NCommonweal"t* 0f Massachusetts Official Use Only Department of Fire Services Permit No. f 7 &k1wi t� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 1?071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work u)be{krtbrmed in accordance with the Mas-chusctts Electrical code{Mr-C),427 CMR 1100 (!'LEAYh'PRINT11V INK OR TYPE ALL 7NFORAfA77ON) Date: City or Town of: NORTH ANDOVER -- t3y this application the undersigned r° the Inspector of Wires: g gives notice of his or her intention to perform the electrical work described below_ Location(Street& Number) ��T rU � � 4/ ()caner or Tenant - 7 �� '��' Telephone No. Owner's Address is this permit in conjunction with a building permit? Yes Purpose of Building �` No (Check Appropriate Box) `� t Utility Authorization No. 41,0 y 6 Existing Service � Amps 1 Volts Overhead ❑ [:ndgrd❑ No.of Meters New Service fia Amps zol LYS volts Overhead :'Number of Feeders and Ampacity Q Undgrd � No.of Meters Location and (Nature of Proposed i✓lectrical Work: (_'atn lotion u the Rom-in-c Rom—in—ctable ma,be tvaived bhY the Inspector o ."'ire. No.of Recessed Luminaires No.of Ceill-Susp.(Paddle) Fans NO:° uta r No,of l.,uminaire Outlets Transformers L11 VA No.of Hot Tubs Generators KVA No.of Luminaires Swimming Fool rua e ❑ u' ❑ 0.0 mergeacy !g !ng end_ Baste Units No.of Receptacle Outlets No.of oil Burners FIRE ALARMS No.of"Zones Na.of Switches No.of Cas Burners o. us tPutection an ti No.of Ranges InitiatingDevices No.of Air Conti .ata Tons No.of Alerting Devices No. of Waste 1), eat amp um er ons o.o e - ontalne Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local p !Intel a ❑ �l�tlfer No.of Dr ors ❑ Connectioa y Heating Appliances KW urity ysten NO.its aloe o oNo.of Devices or E uivalent HNo.eaters KW ° Data Wiring: a Si ns Ballasts No.of DeviE ces or ....... tent No. Hydromassage Bathtubs No.of Motors Total HF a ecommutllcahonswiring: OTHER: No.of Devices or Equivalent Attach additional detail q'desirerf, or as required by fire Inspector of W'irrs Estimated.Value of E-lectrieal Work: Work to titan: t (when required by municipal policy.) �l- / p Inspections to be requested in accordance with MEC Rule 10,and upon completion_ INSURANCE COV ERACE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides P")f of liability insurance including"completed operation'coverage or its substantial equivalent. The undcrstgned certttres that such coverage is its force, and has exhibited proof of same to the permit issuing ottice. CHECK ONE: INSURANCE OND ❑ OTHERS I certify. under the pains and penalties a r' ❑ (Specify:) ftp!u r}'.that the information on this application is true and cv)irlptrte F"1R13 NAitiIE: j z Licensee: 1,EC. NO.: -yy}'3 `` 40 if- -� j�_ Signature Add �hl. d•rt r "('i 1fW it,slit-license numher litre_) _ E EC.�N-o.:�9 ys � 3► >,ddress: � Bus.-eel No.: � � f11er M.G.i. C. 147,,, 57-6 1. security work requires llepartm of Puhlic 5a fety"S" I_icensr: Alt. l el• No.: OWNER:'s INSURANCE W,�lVER: I am aware that the Licensee docw trot have No- t by law. l; my si, e the liability insurance coverage normally Y gnature below, I hereby waive this requirement- I am the(checktone)❑cr.4nerOwner/Agentownr's a gent.Signature l eie huge No.p R 11T FEE: :_e i w 10154 G - el - i/ rDate.................................. l� poarM °!<"`°;••""° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 7Sg,,CMUSEt This certifies that ..............Q. has permission to perform �' 7. .--7..... ............ .. .... . ... wiringin the building of i1! ,�!' ' ..d� 8 ......... .. ........ ..... .... ......................................... at.......Z.`1� .en ..' ..`........./''2...�f:n............,North Andover,Mass. 00, Fee..... ............... Uc. . ......; .......................... i ELECTRICALINSPECTOR Check #3flo 1 r Permit No.- __ le .3 V 1 cpm f n.nf .Il et trvica! ,- Occupancy and Fee Checked BOARD OF EIRE PREVENTION REGULATIONS Rev. 1107) (ica,e blank} APPLICATION FOR. PERMIT TO PERFORM ELECTS 1 yAi- WORK All wort-to be per(onned in accordance,vith the Ma'ssachusccts Elcct:iczl Codc(1Z�71(,o -21 CM I2.00 ?LE.-ISEPRryTfNIliKORT)`PE,4LLLVFON,,4TION) 'Date: It L t City or Town of: /�r 19D=ba-)�;L� _ 1 o the Ilas�ecrar of!Y'/r,^es: N BY this application the undersigned eives notice of his or her'intention to perform the electrical work described below. \ ^� Location (Sicca & iiurnber) P( r O}rncr or Tenant TeleP hone No. Owntr's Address Is this permit in conjunction with a buildin,permit?+ Yes ❑ No (Check Appropriate Box) Purpose of Buildingtttiiiil�Authorization No. Existing Scrvice Amps / Volts . Overhead ❑ Und-.rd❑ . - Vd.-of Aleters New Service }rrnps / Volts Overhead ❑ Uridgrd ❑ N.. ofNIetcrs Number of Feeders and Ampacit}• Location and iYature of Proposed Electrical C omoletian ofthe following rable mai.•be waived br.rhe(marcror aI If ices. « No.of Recessed Luminaires No.of Ceil=Susp.(Paddle)Fans INo. of ar, li L21 _ No. of Luminaire Oudets No-of Hat Tubs Generators _ RVA 4 above In- t o.of mergency t� ting ' No.of Luminaires 'S�imming Pool arnd. t=rnd. Q lBattery Units \'o_ Of Receptacle Outlets �Na-of Oil Burners FIRi,�L.4RMS .Clio.of Zones 1o. of 5vitchc's Ilio. of Gas Burners f�o.of tteand Jnitiatinz�Dcriccs No.of Ranges 1o. of Air Cord. No.of Alerting Devices _ Tons No. of W;Iste Disposers Fleat�ump [�cumbcr ons Its.' o.o c ontaine P Totaty�-`��- -- Detcetion/Alerting Devices ' - No,of Dishw'2shcrs Space/Are. Heating 10Y Local❑ Municipal 0 Other Connection - No. of Dryers Hestina Appliances eturity vstems_° rY No.of fieviccs or Equivalent o_of Water K-W o. of Data Wiring: Heaters Signs Ballasts No.of Devices or£ uivalent No, Hydrornassage Batht-ubs No.of Motors `Tpiai HP elecomtnuntcaiions icing: No.of Devices or E uivalent OTHER: �8) attach odditjonu!detaif r'f desired,or as required by the Impector of 1f'ir6. Estimated Value of Electrical Work: .J (When required by awdicipal policy.) Work to Start: �! Inspections to be requested in accordance with NEC Rule 10, and upon completion. r INSURANCE COVERAGE: Unless waivcd by the owner,no permit for the performance ofeleetrteal work may Issue unless the liccnsce provides proof of liabilin'insurance including"complctcd operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited prenfof same to the permit issuing office. CHECK CPE: INSURANCE ® SON'D ❑ OTI-IER n (Specify:) self Insured I cerlrfy under the pains and penalties of verjur)•, thar!hc in rrr40on ort this application is true and complete. FIKhi NAME: P-DT Securat;� Services LIC.ASO, � 'V Licensee. Mark A. RrophV St�nattrrE_t � LTC-NO.: C-45 (//applicable. elver •'e.:errp:'•in tiro licaur number fint.) Buc.Tel.No.:, S 9S-59; Address: 3.8 Clinton IPx'i'e• Hopis,_ ;'*l 'Pct NS.G.L. c. 147, s.57-6i,sccurit)•�votk requite,L)cpart:ncnt of Public Safety"S"License: Lic.No. 00993 OWNER'S INSURANCCE IVAIVER: J ars 2warc that the Licenser does not have the liability insurance coverage normally required by la N. -By my sigaatLrdbclovr,S Ircarby waive this rcgssrerncni. f am the(check one)❑owner �l owner's ascnt- 0 n•ncr/Anent F'ERhf1T EE: -� "r c: ti i i "Tz;-'Rr; �92$ �C.��U��'LCY.f2C'l1fj.G�� !�-• t-'`rG'GC?l��Q:t.'�2{,l.[��? f K Department of P' blic Safety Une �,shburton Plane, Rm 1301 Boston, Ma 02108-1618 License: S-License Number: SS CO 000953 Expires:02fU7e2_0 i t Restricted To. 00 MAKK A DR011HY SR Tr.rtrt: 117 0 Keep lop for race:pl and chango of address nolificavun •'�/r•' �•olN zrtt•/t.cwrJlll rf. J!:1rFi rt�.�r'� i DEPARTMENT OF PtiaLIC SAFETY is Number ao^S ro iRD]"_53 Explras: I _ Tr.no: tS?3 S-License: PX0T_SECUfiiTY SERVICE Silt A 3ROPHY Sit l MORSE ST IR:'00:). MA 0_V52 J�"' �"`r DIG SAFE CALL CENTER: (888)144-7233 Cuig�ur�icmac i FW,Th.D b=h Many AA PorWUfta F- t�[1MARC3tdifiiF ►E.'[H OrMASSACHUStE�'T5i BOARD F A A REGISTERED SYSTEM COWTIt ACTOR- ISSUE'S THE AUM l.lW46E TM l i TYPE •ADT ,SECURITY SERVICES, INC. MARY.:.p DR 01?HY SR � -C 410 -UNIVERSITY AVE =� WESTWOOD KA 02090-2311 849174 45 C 07/31/13 849374 I f~ Fdd.Tarn AeWch dlci�y At Per:araUans � . M X0004 Date.................................. NORTI� O�t,.ao��,4, 3: o� TOWN OF NORTH ANDOVER S PERMIT FOR WIRING SS4cMusE� / This certifies that �� has permission to perform .W.� �- ......:s.................... winng in the building of ��SS ' /� !/l .................... ........... ...:..................... / '. ........................................y y �. .. .... ..... North Andover,Mass. + Fee..l..v.L"..... Lic.No `� 3 ......... . ......yy.. . . ... ..... LECTRIC INSPECIyrR 12,Check # �� V I. Co»irnonuiealth o�///a�lachu�e6 Official/Use Only 2eparbnen,E.,1 ire Serviced Permit No. Y , , BOARD OF FIRE PREVENTION REGULATIONS [Rev.Occupancy and Fee Checked 1/071 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 WK OR TYPE ALL INFORMATION) Date: 3 -? / — // City or Town of: &-- 1w v e, 4 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) 5/ c/ IZ1117 Owner or Tenant S 7` Telephone No. Owner'sAddress ' aim( Is this permit in conjunctiou with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building i H�, Utility Authorization No. AG Existing Service Am / Volts Overhead❑ Undgrd❑ No.of Meters New Service 7&y Amps Jed 1 ZytU Volts Overhead❑ Undgrd 2'— No.of Meters Number of Feeders and Ampacityjs -` Aj/,t ", /�v✓3 Location and Nature of Proposed Electrical Work: Completion of the ollowin table mg be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators K-VA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency ng nd. d. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW o.of Self-Contained Totals: . ... ............. ........... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ unicipa El other Connection No.of Dryers Heating Appliances KW SecuritySystem—EF No.of Devices or Equivalent No.of Water , No.of No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Eq uivalent ' No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 3 / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCES BOND ❑ OTHER ❑ (Specify:) I cet7ify,under the pains and penalties of per ury,that the information on this application is true and complete- FIRM NAME: �. S,� f eciC LIC.NO.: X49933 Licensee: ,, i6, 4e J ,S,,�sSignature LIC.NO.: /fib"/7& (Ifapplicable,enter "exempt"in�the license number line. Bus.Tel.No., 9;7r-6-J'!7--V109'Address: 9 /A.bUCJ`/y �i�ol� �or��n��b2'l1�ii� O��ys Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owper's agent. Owner/Agent Signature Telephone No. PERMIT FEE. d.Z- j ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL F1.ROUGH INSPECTION: Passed— Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 2.FINAL INSP Passed—[ Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: r (Inspectors'Signature-no initials) Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: I it (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: Nom: Passed--bd Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: l (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. !Yj BUILDING PERMITNORTy Q SgLlO 16�� TOWN OF NORTH ANDOVER 32 6;.t' `° °0 o I APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �SS Date Issued: — — ACHUSE� IMPORTANT Applicant must complete all items on this page - z, 1 ro ; , � 'Za r - a 5� � 1 t xr -s t t c,�y. ,r ` y 'S,+�nv•a��€r r'*a r-c�-i�-..t.�•i`ti .,,�,r',-4 73 i, ' 13 c F s r. �. i rpt�` ?r51-•.f +y q, sc` �"e -[.':t -711, -4M12 -s• r�f :�rlll +fl.. ., .. 7�y •� f t Ali-'S�''. r�. •�' € _r, .. 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'3. y "`'1a �r¢7 z S�-w�}•f's t -7' " ;,� a, � z � r;SY��•L:3�1 - ;M1tin lad :, + �G�� rY r r+rn��i�+N'h L r`i 7�fi v ��is 7>:-3r Svl tf!•}: i + r8''• r�r t ='�14-, 1 M1 t4sntirg `�-s*-e 'h'.`f spy:ci.. 1.: 1�' iu [,�'r,�•}.�' s., • ^� , '4 n r•^.� L 'rmf''-,�.�'It a„- h r; 5,,,� `Ss ��^, 't-t'{c� a--le-.:n�h.�•,`F j mtle�a r e .sr� SG�,f t w,m,.<s�.r'S i:``r��n35 a�.�� ✓�.e�' t--rF � � r'�k5• 'i 'rel ' � ¢{� •�•�y�%i).y� �7 � C i _I 5i, a r'Y>c s. 1 s, r c .��2 u in ei y,,�f,r.,,. •.t�^"�Ci��.�m�.�. .r+� *s va�,fyz: �,k�r+i�t�S."r's uiU.k- �,wr- 't'�.i �,r'.1 •t Y y:.-a ,m-N_.SF.'+_��,�+i��.s �nE� -;p�a`k , S��>��s�m.+`#; ��,�T•�� `�,tF `h"��'� r.�K��i�'' �rF«-��.��L� 7nt{art ��rk�'25�r �1 t� {e�t�� .t�lc2"} 1 - `2,'{�,,as � �ajl .,C-�'C�LL�",t+P�i "�? l }.: 'c_ -'J• �...�..��t-Y 7..K••r,,. .3&�`.'!,-_S� �.,ltz,!tP:.:a..,;rY .+ ;_!..�a�,�,�`,-�.•� 3..E,::.?,��JW��.��. 3YN]a�Qi��x'°�/- e�'�U 1 �D .a•;Ff fJ'• TYPE OF IMPROVEMENT PROPOSED USE Res' Non- Residential New Buildin One family fA ition wo or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition- Other p � �' ,� '''--.c- .,�y, �. s 1,y�� ar.' � Ll ^°4 ;E •IC �i., aNl �-1�. a,��"'�SxCan�M��n� 'Mi": M � wn �•�+�. '" k,� �`ff�, � 5w'��.�j",} =r. •:-._:-... 2 .. l�E, 1 sa�:%�t '�*'t��3''.; ` r cf•-'�_�'•`�},': .. ...M1 's.n�`,J`'. ,y�".w;c.w' « �. DESCRIPTION OF WORK TO BE PREFORMED, nit �l or, DN entification PIease Type or Print Clearly) OWNER: Name: LC._� Phone:! 7 ��'��3/®7i Address 5— '4 p�j+Y r'�b- � "�7r4 gS'4� .#K.'S'1''t.-.�^a``r� x.- L..,w - Y,� i' '} +,,,•,....} C,., �- r, r rr7 r'S `�•..5^'wvF'.3''r+'i`.'F� �"aS. �� h..• "2r �I z.�"+Y � `. �N"�.�-`'�L'�ize^".ys$,� �K �xr � t „v.,-1�1, s w.' . a '-Si1+ ''� n `�' .-•Yu�� . "� -+Oxy' ni� �`�r�'n n rte.r4y2,.�� 5� :•e-�s�Cw` e`a. 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No.�o`Z�7Lj— r'Appeals FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ;recording � Total Project Cost: $ '��ll�j/rr ' t� FEE: $- Check No.: 1"3� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces guaranty.fund Si na urE,SIA ent/QwhE e �.9natwre of poI ract�r laps Submitted Plans Waived Certified Plot Plan TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massa-•--_� Well --1� pepartr�ent ert'r►it to be obtained• 61r%19 Private(septic tank BU1` t'or the app�opTiate P . ed foctn5 to be filled ou t e�equ%T P erre;ts lis of th r Rehab;i;ta�•�On ,Ibe following�s a ,rterio S;dir9� N\Gtion '00AVIg' Pefmlt APpdaVit S.L• en t1c ses guildin9 �omP A Tl ce of Bidg perrnit Qr G o ers 1 G• A n o ?°to GOO �ac nterior W°r d VOducts ent prior to issua o ph °{ Contra used i meere P epartrn GOpy Or Prof o dor Eng Fire o r Plan avlts firom o FiO°ineerin9 A sldrequire sign ° o Eng Stec perm) 140-Te-. Ni dvrc'p ks . dd;t;°n Or_pec tlon P► P ermit A a P,Ot Pian in9 e es kier Plan And A G.S•�• L1cen Ork�N It Sprm s ° Bue,�l�ied Survey �idavit � ° Workers G°op N.1.G• And Gf Proposed o photo GOOontract Ia1evat%on Pian bie) 1f APplicabie� ce of Bidg Per GOO � sectionl 1� APPiica ort� uan ° FiOorlc . Ga`culatio coin ianc eere Pr°dUartment priOr O ass CO o v,1c Hydra e�K.F.nergy. JOT ErlglCl FireOep iv'ass ch O� in9 AIdav1;e sign frOn' oEng1 s ee permits requ d Tw° F arr't1y� Zoning E NQ ' Pii dump on ls�n�le ar _..y Ne`N G°nstruc APPiicat 0n n S ier Pian Planning E Per6Ut oP Piot , is ceases lncivae Prink. v gul�ae�`ed ?Top°send G•S•L' L1 e Returnedl to ConseFvatior o Photo O� N'otGP Ajiidavi`ans (pne T° ) Wat6r& Se ° Workers Gof Bn9 P 1f APpllcabie� f Bidg ° -two Sets GaatlOns � FZep°rt cts to issuanoe ° DPW Town E ° Hydra of Contract Go,mpiian veered proepavirnent pr,or from tile roof O Gop s ch k Eneda its�Or o �r°m Fire D Taus stamp the decisOne copy and P 'I RE ° ec eds Located'at� A ° Mas eerin9 A egUire sign ks office mu aistrY°f De aiaaej Engin ermits r TownCler attbegefl o d°mpster P w wed the is recorded as reg Qet th C� �I1IF?ITS . : TE: NQ Pal s eciat Per V�ant must then b . variance over- or P The app Vcabon A cases I eal Per wa is b the bu00i -'app tbat the app vaitted oils,be sub s m zoo We* goildtn>perm►tRevised BUILDING PERMIT of V&ORTy TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONso Permit NO: 0 �1 Date Received 4��~�-• ^' Date Issued: gc►+us IMPORTANT Applicant must complete all items on this page ri h vs y r a ,..% � -rb �9`-sr` ,�r?�Llr�yi jlf PQM wr,_._ s 5 i � T.}� qq - J it r. + ' 7'1�1� '"'- x r %1 i �s. - ^+, .�fff .. 1 ,, .+�. Al ;, 'S rIn-tt �+'ns n^f.,�i�.- ,�� a'"'.r•c rri_;?�W;"'�` �ty Y e- S�;.Yi':��'1�""r,�,gr1�..�s.+an't s3�"s�n' }ryas t"7FJ'v'r'7`y',,re �f.. 4q)ee.uvtY.S�f � ...,1°�Il�•C�IEx.. S ✓a .ty � hSf�' J�tF�i•-'L"Fi�Q�ril-Y•��*� va�:� .e,'3a-i �'^i I� t t n�i.��h �2f,_ �.i y-e. �, ��. `� .is R 5�d�+�hr,'�`{y�E„Rt��r._.@.'•`�.�.._ �'tY _z •� tlr �i.`�'�-K ri„ y�wCJY� ''�nF,O i9'p.. TYPE OF IMPROVEMENT PROPOSED USE Res' Non- Residential New Buildi�. One famil Ad ition wo or more,family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition— _ Other y 9ia� sry�`s ° ,�+6 IY.z ...k, �� ' + La7 'f.:.`�4 J'� i'�tt4.� nr�J'4'y.t�+' t .,...,,_, ...__ .� ......:.r<�:• r.a"'S.r=�� ,.-�, `tc��",a...�.°'� "r �'2. ��a�l,rv"'R tf .�s>�,t. "'�,, '�� DESCRIPTION OF WORK TO BE PREFORMED: �- �i ()n ON L c�entification Please Type or Print Clearly) OWNER: Name: Address ® i tl e -Zr£4:Y {-a, .,r 1. 'Jig" g r } �'�af 2 "-� 1�.�•� y� -n `�.',�5'"-�w r. Cn'ai,m5'��y5. �'�"` `+k�rd,`��i:N J ,qJ�r- �:�a-,r--i'r�1 ly`�e` �4rN,�sv`��-•4C _ �aG4k�y ^ �r N' �7��?u'z-at"'rN •'P- h-s-w�zr�faa_ �-x.r t a �"+_# t 4� Ya ,� Wk. •y, r r G,; .r-qi n r� 'r"" 'avow.;, - 4eG`�,`•,c . ' J.: -qx gra A r - a , - ..f "iC'.s�ta Jd},vVk"�•--�Ge tk ✓� `rte, a 'fir ir't. OWNrF.S.•'r3 {€S.rx ,e'E f"'v '{ ,si`t i 'st "+RjF'ty�,'•u�` �r 3:� 3��Wd-ka r �-.. -, F �.5! M :G c3„h � y, � i �f� � ,,� �1'tnFF�1 mom, 'lv� �5 �f` �7��, �,I t, �t � YLA �1PA.I,. y•JfN'1 �'.`] } ' �yJflY .�4,M17�iI-.Y'.a f +- ` d4Y '�6'^y ��AQg � �! *# ,.n arse-.,.;-_ },F, fit- -a.•'' Fs � 'vCRKa}PiEMTnl,Yti��'e`�'. ARCHITECT/ENGINEER , Phone: Address: �e rrr Reg. No._'-�Lg2-24,5" FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ "I-Db/Ily�'/ �!� FEE: $ Check No.: - Receipt No.: NOTE: Persons contracting with unre istered contractors do not have acces e guaranty fund 777:— �l S_gna�ure;�..;Akgent/Oaruner - agnatureof70onTOaetor ` Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or..D ecks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit --New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Piot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 L i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine i NOTES and DATA— (For department use) k ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 lans Submitted Plans Waived Certified Plot:Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Si nature OL 6!ex!� 1..0IVINPIE v I S HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water $ Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street aIZE � ATN17= T TerLDu seer ontt� P y L•ocated�t��ylain Siteef , r ,�_ , �. i �, } Location �5' �m��7� �C//?l� Z-07#10 No. Date f�CU NORTh TOWN OF NORTH ANDOVER 3?0�,,..o ;•�tio 0 f w Certificate of Occupancy $ Building/Frame Permit Fee $ s,,,cMusE Foundation Permit Fee $ � y Other Permit Fee $ �1 TOTAL $ Check # —�y 237 Building Inspector i ORTN o _ 5 TO" Andover -o dover, Mass., O LAK COC M IC KEWICK V ADRATED PPy S BOARD OF HEALTH Food/Kitchen ...PERMIT T D Septic System . rr BUILDING INSPECTOR .. .. THIS CERTIFIES THAT...... . ...... �k.�.f' . ........ ............................................................... Foundation has permission to erect........................................ buildings on ..............��... .....�!1.Z ... .............................................. Rough J� Chimney to be occupied as..... -.. Q.............. ......T1................................................................................................... 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 b� PERMIT EXPIRES' IN 6 MONTHS UNLESS CONSTRU N TARTS ELECTRICAL INSPECTOR Rough .............................................:...................:.......................... 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. The Commonwealth of Massachusetts I Department of Industrial Accidents �Amu Liy7 Office of Investigations 600 Washington Street "3 Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Le ibl Name (Business/Organization/Individual): L LLC Address: ` C City/State/Zip-_�:O�C':dlq_p M � O NZ 1 Phone #: 2/0 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 2.4I am a sole proprietor or partner- listed on the attached sheet. # 7E] 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 10.❑ 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.❑ 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. 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 acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 fonn 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 herebce under the pains and penalties of perjury that the information provided above is true and correct. Si nature: C Date: Phone#: 7 " 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 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)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 cavy 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 pen-nit 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 pen-nit/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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia