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HomeMy WebLinkAboutMiscellaneous - 440 WAVERLY ROAD 4/30/2018I M6 Location/Y IM Vf ko Y No. Date Q3 TOWN OF NORTH ANDOVER M.- 0 41 Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ =,2 Check # R� ((a$", 16101 v Building Inspector t V) D N/F ROACHE TRUST EXISTING RIGHT OF WAY (UNDEVELOPED -50' WIDE) 138.00' LOT B 0 AREA=13,800 S.F. 39.86' � w o � EXISTING o w o o CEMENT CONCRETE oZ Q FOUNDATION 7-:2 39.76' a J J 3 in 17 Ir - fn - 138.00' - WAV E R LY (PUBLIC -66' WIDE E.C.L.O.) ROAD -0 () 0 � T►\AN s �0-Pk- v " I HEREBY CERTIFY TO THE TOWN OF NORTH ANDOVER BUILDING DEPT. THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN AND THAT IT DOES CONFORM WITH THE TOWN OF NORTH ANDOVER ZONING REGULATIONS REGARDING SETBACKS FROM STREETS & LOT LINES." " I FURTHER CERTIFY .THAT THIS FOUNDATION IS NOT LOCATED IN THE FEDERAL FLOOD HAZARD AREA. SHOWN ON F.I.R.M. COMMUNITY PANEL #250098 0003 C DATED: JUNE 2, 1993. F STEPHEN DA E PLOT PLAN OF FOUNDATION LOT B WAVERLY ROAD IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR NARDOZZA REALTY TRUST 423 WAVERLY ROAD NORTH ANDOVER, MASSACHUSETTS 01845 SCALE: 1"=20' DATE: JANUARY 8, 2002 MMMW CK ENGINEERING SERVICES 66 PARK STREET ANDOVER MASSACHUSETTS 01810 Location 9)A G/,f No. WOOF Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ 515- Building/Frame Permit Fee $ Foundation Permit Fee $ C-) Other Permit Fee $ TOTAL $ Check # 15986 Building Inspector TOWN OF NORTH ANDOVER Y BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING . BUILDING PERMIT NUMBER: DATE ISSUED: Q SIGNATURE: Building Commissioner/I ctor of Buildings Date SECTION i- SITE INFORMATION 1.1 Property Address: 1.2 'Assessors Map and Parcel Number: PdA Signature Telephone ! �. Map Number Parcel Number Not Applicable p 1.3 Zoning Information: 1.4 Property Dimensions: 7P Lla �5 ► n9 le 1-�w..1 1:3. F(00 ZoningDistrict Proposed seUseU Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yaid - Side Yard Rear Yard Required Provide Required Provided Re red IProvided 1.5. Flood Zone lnforma[ion: 1.7 Water Supply M.G,L.C.40. 54) — / Zone 1.8 Sewerage Disposal System: Public OJ Private 0 Outside Flood Zone a** Muuicipal y An Site Disposal System 0 SECTION 2 - PROPERTY OWNERSIItP/AUTHORIZED AGENT 2.1 Owner of Record 104 9 Turn) ;1 c P S+. n Name Pint) Address for Service : Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone CL�/'rTTAI�i '} /'A1�in TTii/�mT��t r - vl\V ll�v <.11V1\ JIil�♦11. L'J 3.1 Licensed Construction Supervisor: Not Applicable G Licensed Construction Supervisor: I g� 1 O ►-I 9 �y� tn1 ni%te Si-. License Number i Addres , X Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable p Company Name Registration Number Address Expiration Date Sisnature Telephone c-vt-grrnty A Wn1DVr1Dc rnMMF.NCeTinN (M -C. -i_ r 152 8 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will re alt in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: G0ros -f-0C11"6y) of a Sir�a1e, Fo►,r;,� . Ot,)eII',^4 (.0 l +h 0. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY., 1. Building(a) -75000 Building Permit Fee Multi lier 2 Electrical ` (p OO 0 (b) Estimated Total Cost of Construction a�t [ �0 �-- q( 3 Plumbing Q 0 Q Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection —" 6 Total 1+2+3+4+5) q -5f OOC> Check Number SECTION 7a OWNER AUTHORIZATION 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 permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, i..dJ i 1% i arv. 0.t' f' -NA- 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 s Signature of Owner Rent Date NO. OF STORIES SIZE i 9 BASEMENT OR SLAB a t e 'C' SIZE OF FLOOR TBABERS 1 X1 2 '21,X10 3 X 1 SPAN 13' DIMENSIONS OF SILLS L4 X DMNSIONS OF POSTS H X DRv ENSIONS OF GIRDERS H `d. X1 HEIGHT OF FOUNDATION THICKNESS 10" SIZE OF FOOTING I ©IN aU to X MATERIAL OF CHIIANEY r>O0'e- IS BUILDING ON SOLID OR FILLED LAND SpliA IS BUILDING CONNECTED TO NATURAL GAS LINE • 4,µ `.� 1 V1 1� i� V i t.J L11NJLJ i V1\1t1 �. IiNSTRUCMON& This form is used to verify that all -necessary approval/ permits from Boards ,and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. suns mmen a am a no m m e e sons a as am no anon meam a nee an e.m ■ am a a am men ones a m a a am memo a a m m am a APPLICANT (-A-)'% a r C,'PHONE (v �a -;a 3 Q ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET�: t C1 STREET t-/ SIOmmomm N weR wn 2 �NUMBER as a a Boom so as ..... . OFFICIAL USE ONLY so RECO TIONS 0 TOWN AGENTS Imememm ■• ne names ■an mmm mm mnn emmea enmmme■em maaemm ameemameemmemnme emmmmm■ DATE APPROVED COSERV TIONAD TOR DATE REJECTED COTIIv1ENTS � O7'1 14-17 ' / ' i2��� DATE APPROVED I O /Zo-Z bft P DATE REJECTED CONMIEENTS DATE APPROVED FOO SPTCTOR - DATE REJECTED ` DATE APPROVED SEPTI INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS I "' D �/ROVED AZ IR DAM D COMMENTS RECEIVED BY BUILDING INSPECTOR DATE MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 9-27-2002 or 2 family, detached Other (Non -Electric Resistance) DATE OF PLANS: 9-27-02 TITLE: PROJECT INFORMATION: 440 Waverly Road COMPANY INFORMATION: William Barrett Homes 1049 Turnpike St. No. Andover COMPLIANCE: PASSES Required UA = 435 Your Home = 389 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 936 30.0 0.0 33 WALLS: Wood Frame, 16" O.C. 2108 13.0 3.0 150 GLAZING: Windows or Doors 266 0.350 93 DOORS 62 0.350 22 FLOORS: Over Unconditioned Space 936 19.0 44 BSMT: 8.0' ht/6.0' bg/2.0' insul. 300 10.0 47 HVAC EFFICIENCY: Furnace, 86.0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer..-. \ 0-0-(4 Date (� GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. W'LIlia,nr. UJ e- Pa Permit Applicant Property address Map / Parcel 9I9`6`9a- a3ao I v/ Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 ofthe Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building, permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw, provided that no additional residential unit is created. —A.Z The lot(s) was / were created priorto May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are me and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land. For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved bythe planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUNDS FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. AP LICANTS SIGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION Town' of North AndoverNORTH Building Department O = Z. 27 Charles Street ~ North Andover Massachusetts 01845 � "_ 4 (978) 688-9545 Fax (978) 688-9542 0 '�"'4 �9SSACH� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit .# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: S0r\rev1-�\v\.)0 '0i Co. ility location r Signature of Applicant /,o /Z Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: city Phone am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. � HomeS Address I O L4 9 i'u r ru Q iL lee- S'1' � City NOtonAav-eg— Phone #: 97k -(v 8'A — 2320 Insurance Co. PY far% ik Ca Somli -y r140- Policy# wQ 95837G 97 04 Company name: Address City Phone # Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGA 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Print name LyiIitaw, %)o%.rr►rie'8�— Phone# (99a-93ah Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION 1 835 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 14- 27 1 g-- 26r'--> Application by the undersigned is hereby made to connect with the town sewer main subject to the rules and regulations of the Division of Public Works. The premises are known as No. or subdivision Lot no. Owner Contractor in �/t/ L` C Street, Street �Z/ Address Addre56) Applicant's Signature PERMIT TO CONNECT WITH S ") (- The Division of Public Works hereby grants permission to to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date ER MAIN Street Division of Ppblic Works By See back for rules and regulations 1196 APPLICATION FOR WATER SERVICE CONNECTION ti SP North Andover, Mass. Application by the undersigned is hereby made to connect with the town water main in JV &ytf Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. or subdivision lot no. zz)! � Owner Contractor Y1 os no elle( vvi 1. K Street Al n, Ike Address Addr s Applicant's Signature PERMIT TO CONNECT WITH/, �A/ATER MAIN The Board of Public Works hereby grants permission to!�4 YLt G to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. Inspected by Date Street See back for rules and regulations J.WILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 so , DRIVEWAY PERMIT Telephone (878) 685-0956 Fax (978) 688-9573 DATE Z7 o LOCATION BUILDER phone Rf OWNER G I �✓ hone �9 Z THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. X A PP L L CA NT- 6-5 siGNA-T'veE M 0 m N N d CD \k§ \ ®� CY) k &fib � �$ƒ ` k w�. �{ 0zo < \ 3 p G G § U. co §_§ 2 § § 0 k m 2 CDk Go mPA ■2ƒ 2 w e s 2 L E7§ ■<� ME£ �ƒ§ 2/R llm S$I k3z REQUIREMENTS FOR BULDING PERMIT SIGNOFFS rte. BY BOARD OF HEALTH To be filled out by the applicant and submitted with the Buildiny, Permit application 1. What is the proposed project? Deck pool addition new house other 2. Are plans attached? Yes (For additions and new houses on septic systems, No complete floor plans of proposed construction and any existing house must be submitted. For pools and decks, a site plan with location of pool or deck is required. Dimensions of deck are needed.) 3. Is municipal sewer available at this location? Yes No 4. If sewer is available and a house already exists, is it tied in to the sewer? Yes No 5. Is the, location served by private well? Yes No 6. If this project is an addition and the house is served by a septic system, has there been a Title 5 inspection done recently on the septic system? Yes No 7. If, yes, is the inspection report on file at the BOH? Yes No Workers Compensation Insurance. Policy YIARYLAND CASUALTY CONIPANY Information Paze NCC1 Company No.: 10545 and Employers Liability ZURICH ACCOLNTNUMBER: \4006i33531-001-00001 Bran c, Poiicy Number Producer Code ` Previous poi icy :dumber I I tE` E�VAL .�GBli ILN' WC 1):437697 04 02090918 I TCI 1)5837697 03 Branch address: 15 MIDSTATE DRIVE AUBURN MA 01501 1'TENI I. Namea Insured ana Matling Address Producer Name ana Mailing Aaaress COLONIAL DEVELOPMENT CORP. DBA TARPEY INSURANCE GRo P. r. C. WILLIAM BARR=1 HOMES PO BOX 567 1049 TUPNPIKE ROAD WAKEFIELD MA 0 1880-1667 NORTH ANDOVER MA 0 1845 -6109 (780246-2677 This Information Page, with policy provisions and endorsements, if any, completes this policy. Insured is: CORPORATION Risk I.D. No.: F.E.I.N.: 043201987 Other Workplaces Not Shown Above: SEE SCIIEDULE OF INSUREDS AND LOCATIONS rrE1N12. Policy Period: From: 03/24/2002 To: 03/242003 12:01 a.m. Standard Time at the Insured's Mailing Address ITEM 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Empiovers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 33A. The limits of our liability under Part Two are: Bodily In by .occident S 100.0()[') Each Accident Bodily Injury by Disease S 400.000 Poiicv Limit Bodily Injury by Disease S 100. C00 Each Employee 1C. Other States Insurance: Pan Three of the policy applies to the states, if any, listed here: ALL STAiLS EXCEPT ND. OH. WA. WV. WY. NV AND THOSE LISTED N 3A D. 1 his oolicv includes these endorsements and schedules: SEE FORMS AND ENDORSEMENTS APPLIC.kBLE LIST ITEI�i -i. Ine premium for this policy will be determined by our manuals of rules, classifications. rates and rating plans. All information required on the foilowing Classification Schedules) is subject to verification and change by audit. SEE CLASSIFIC.vTION SCHEDUE Total Estimated Standard Premium S 1,660.00 If indicated below, adjustments of premium shall be made: D'emium Discount S '' � Annually Expense Constant S 244.00 711 Semi -Annually Premium for Endorsements S C Quarterly Taxes and Surcharzes S 78.00 ❑ Monthly Total Estimated annual Premium S 1, 982.00 'Minimum Premium S 500.00 Deposit Premium S 1.982.00 9 LUue Date: O2.,Ig/2oo2 �'YC 00 00 01 A ( Ed. 10-10) NSURED COPY Cdunwstgned By Authorized Representative CnnvnL,nt. 1997 Vatinnai (nnncri on Cornnensatirtn inevrrnce w H 0 z O kL Z O FM a 0 z O LL a z 14 Z O Q Q U X LU C= C O -0 O o0c CL U ✓ W � O N C Q � n Z LnA ,-* U >° C� 3cu 4 C= C O -0 O o0c CL -0 ✓ � N C Q n N LnA >° C� 3cu 4 g y C u.. OZ C ru "" tom! 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N M CA m x ci M co 'o _m u* � 8'-141 02 5/8" owel) w �- o= o CP o ce \ n r • � ifiin , �tititltit�':_ 'llfltifitifl mo o 39. N M CA m x N Ia x O o= o II� 1 1 11911, L m m J6 �� U i tp O E RD 6u16pi�g aty��a�ua� u� I101r 1161 U0,01 N_ c �V x N r 1 O� O W m mOto � qQq x N L U O u- � O IW x x x ' O � � — 1 Otj m x N aum (L LU �o u `no o h � 1 I Him O O x x rL N tV 6u16pi�g aty��a�ua� u� I101r 1161 U0,01 Cc OL N_ c O x N r 1 O� O m m mOto � qQq x N L U O u- � O x x x ' O � � — 1 Otj x N aum (L LU �o u `no o h � 1 I O O x x rL N tV LLL Q Cc OL �O N c O E � L U O u- � �O N Date ... 3.-.1.3-J).3 TOWN OF NORTH ANDOVER PERMIT FOR WIRING U U A.,k) ....... This certifies that ....... 5 ....... ........ ... ..................................... has permission to perform .... PJ&P�y ....... ��N ................... .......................... wiring in the building of .... &.Y-x�41 ............ I ... ..... L4qo UVAU-eft CP at............................................................................... . North Andover, Mass. Fee ..... �. 5 ....... Lic. No.:;�q 5�60. I..-Il/.A. N.(. Check # ELECTRICA, IAPECTOR 438 b- TBEC0AW0NWE4LTH0FMASS4CHUSE77S Office U ly DEPARTMENl0FPUX1CS4FE7Y 5 Permit No. BOAROOFFIREPREVE MONREGUTA770NS527CNIRl2..9 Occupancy & Fees Checked APPLICA770-7VFOR P ERMUTO PERFORM ELECMCAL 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 -7-1:3-o3 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street � Owner or Tenant towner, s Aaaress Is this permit in conjunction with a building permit: f Yes ED No F-1(CheckAppropriate Box) Purpose of Building 1&-4 / e4pl?t/ r, / Utility Authorization No. Existing Service Amps / Volts Overhead F-1 Underground No. of Meters New Service Amps / Volts Overhead r-7 Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work G Q r No. of Lighting Outlets No. of Hot Tubs No. of Lighting Fixtures Swimming Pool Above ground No. of Receptacle Outlets No. of Oil Burners No. of Switch Outlets No. of Dishwashers No. of Gas Burners No. of Ranges No. of Air Cond. Total No. of Sounding Devices Tons r -/,O i' vt-i No. of Transformers Below Generators =round No. of Emergency Lighting Battery Units FIRE ALARMS Total KVA KVA No. of Zones 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 No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal Othe-� Connections . No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP iT'NFR • /_/ f/Yi'/I �Gf i /T �q � G� auarxeCov Rns m t$Dthem4me xmMofNb%w MCen I-aws tawaamentLi,,bilt15'hn==PbkyirtixtffgCorr>plele Cowageottisst>bsfanbalegmalent YES NO avesubmtbdvandpudofsametatheOfceYES F71�>f}ouhawdmdYES, P1W'-rrLc*drtypeofC0WWby gthe box SURANCE BOND OTl�R (P�aseSpetafy) xk1DSta1t 3/ �S Evim icnDek 3FS11M*dVakteofEbchic�alWolk$ D&� Rapt final a Ati 7e Aldt14 o S't/ %/ l va }' Signatute _ I-ramNo c yS L- _ LrenseNo � --:2 Y V Bt>wm lel.No_ 7 j:� 0 - (0 d��- y Alt Tel No /NM'S INSURANCE WAVER; Tam aware that dieLicet',se does nothave theirs w&re mwtageoritsalbsMtialegtnvalentasral.wed byMasswh mZ C>enetal Laws that mysignahueon dmpmntapphcation waives thisrecltlitarent :ase check one Owner ® Agent ® � Telephone No. PERMIT FEE $ , Signature o wner or gen The Commonwealth of Massachusetts : Department of Industrial Accidents Office of Investigations Boston; Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance. Co. Policy # Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,S00.00 and/or one years' imprisonmentas well_as-civil penattiesjnlheiorm-fa-STOP 1NARK_ORDFRar d a.fine�F (31Do oo)-aAw..against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 4 / do hereby eerfffy under the pa/ns and penalties of pa jury that the information provided above its true and correct. Signature Date Print name Pbone.# i Official use only do not write in this area to be completed by city or town officiar City or Town Permit/ xensing El Building. Dept E]Check if immediate response is regu6ed E] LlcenSin_q Board p Selectman's Office Contact person. Phone A. ❑ Health Department El Other r'.. '. � TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This tqrtifies that ................................ ....... ... le ... C ................................. has permission to perform ...... A).. f I--- -k- '11CZ7 . 1,41 .................................................. wiring in the building of ..... A .. V . 0 . if ........ /--� . C .. q,( ... ............ .. . . ... ..... .... ... .... ... . . at ... q.Y.G) ..... .. Ge !'.L.., ..... .. ..... .. ... ( ...... North Andover, Mass. .................... Fee ... ... Lic. No. ....... ( ... ELECTRICAL INSPECTOR Check # 4383 T11EC0MM0NWF.AL7H0FM4SS4CHUSEM Office Use only DEPARTAfiM'OFPUXJCSAFETY BOARDOFFNEPREVEMONREGULA770NS527CM 12W Permit No. Occupancy & Fees Checked .APPLICATIONFOR PFRMIT TO PERFORM.ELE=CAL, 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 described below. Location (Street � Owner or Tenant Owner's Address L/Nl 11c Is this permit in conjunction with a building permit: Yes [:EJ—No ® (Check Appropriate Box) Purpose of Building 1I /V G C5 dl'�"l c -y ( w S t, U A.,6 Utility Authorization No. Existing Service Amps Volts Overhead Underground M No. of Meters New Service Amps /a yu Volts OverheadUnderground No. of Meters !L Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters KW No. Hydro Massage Tubs )THER - No. of Hot Tubs Swimming Pool Above No. of Oil Bumers No. of Transformers EBelow Generators No. of Emergency Lighting Battery Units No. of Gas Burners No. of Air Cond. Total FIRE ALARMS Tons No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Heating Devices KW LocalMunicipal Connections No. of No. of Signs Bailasis No. of Motors Total HP Total KVA KVA No. of Zones 1.1 e- a �ti a . ;e I - :u n: ..� • .�.r aa� . • u: :rI I c I.� •• •eI I I en r u r.:r •e:.•,e•a.e `• a I� • u.`n,.,. :e. I � • r. -• e• ilre .rtes• a �� •n, -••iter � �\1D ,Ise •r:rre :� �:::•Iurs•••;- r•a ee - �-- 't • Irl , oe:r+r •s.:• ':u :,re 1 6 iej - 1 VIAWM•IAI 1I. Dai Fsftm*dValueofBodncal Work $ Rough Final e: r e Iice wNo BtTeL No. itPss J UiT 16 t AA )Z�/,t A) Alt Tel.% �NER'S INSURANCE WAIVE , I am aware that the Licerm does nothave the instuance coverage orits sttsantial equivalent as regmed byMassachua% General Laws that my signattue on this permit application waives this rern metrient :ase check one) Owner ® Agent Telephone No. PERMIT FEE Signature ot Uwner or gent Other Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for nny employees working on this job. Company name: Address City. Phone #: Insurance. Co. Policy # Company name: , Address City: Phone#: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of cmninat penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as YwB-as.civil penaftiesin-theinrm da_STOP:W-ORK_ORDFRand_a.fineA€_($IJDDM)-aj layagainsi.me- I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby cenRyunder Me pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept E]Check if immediate response is required licensing Board E] Selectman's Office Contact person: Phone #. E] Health Department 0 Other Date.. ................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that LAI has permission for gas installation A/ -< . ..................... in the buildings of .... ri J-�. tl. 1! T . ��7 ........................ at .... ......... North Andover, Mass. Lic. No./( 3 Vf ... Fee..!(. ....... ......... /GAS INSPECTOW Check# 4314 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING - x/31 y TOWN OF N-UfkZ- a ov-,/- BUILDING LOCATION 4 `I O OWNER'S NAME, �) L \ \�G-w� \J RESI(3ENTIAL Ef COMMERCIAL 0' �' 'i1 � ?� NE`fd f RENOVATION Q REPLACEMENT Q PLANS SUBMITTED: YES Q NO ❑ FIYTI IRFR - - 0 0' �' 'i1 � ?� ,5 C9 0 0 Uz X 0 G a M M 0 --{ 0 4 r(1 #Z 4v �� rD 0< o� Z O 0= rr; my cn Er; �0 Z 0 mm m � rn G) m z m 8 C 0 rnv -4 = rn � f �0 s m A D rn 0 I 5 0 z ' im I i m 0 X 1 I 0 C S -i ( X m BASEKIENT I 1" FLOOR 20 FLOOR 4°i F65E .. VALUE OF GAS WORK $ I t COMPANY NAIVE i� ���� ��F, �:` LICENSEE) GASFITTER `S! �►� G66�►C !y`t�►I%W ADDRESS.._ d t 0 -1%j C- `A\0 f(11 C G)1(1 'TELEPHONE # f - 3� tti Y-3 LICENSE i ' ` _ MASTER & JOURNEYMAN ❑ GASFITTER ❑ PLUMBER [0' INSURANCE iC0`1ERf';GE; _— - --- ---- --- ---- I have a current liabi,ihr insuratIqP, . policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked vPs; please irtaicae the type coverage by checking the appropriate box: Liability insurance Policy e Other Type of Indemnity [] Bond F1 OWNER'S INSURANCE WAIVER, I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laves, and that try signature on this permit application waives this requirement. _ ---- - _- Owner [] Agent C] SigilattJry f�f ©wnar or Owner's Agent I hereby cerdfy'that all the details and information 1 have submitted or entered in the above application are true and accurate to the best of my knowledge and that all plurnbi2 ork nd in tions performed under the permit issued for this application will be in compliance with all ertinent provision= nr tlis l41 �ch.n is `' t as Code and Chapter 142 of the General Laws. of Licensed Plumber or Gasfitter FO This certifies that 'T // � & -7 Date ........... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform .... k A 14 plumbing in the buildings of ... T-7 . ............... .... ....... at . . . ........ N-orth Andover, Mass. (D Fee. (Y. Lic. No. e�). .. ....... PLUMBING INSPIfCTOR Check# 57 �/ 5 5 4 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUNIBING 11.1; SACH. j SETTS Date Owners, Nance MA �1 Perm Amount Type of Occupancv N .;K Rcnovii iii")n Replacement Mns Submitted Yes No 0 ,�.w r t, 01�04 13 13 Check one: k Certificate C-0(iii-1-0111y Namo. C.t 1-'r` c Corp. 0 Addnets} 7-35�j W. 7, 1 7-1 --1 1 z , 4A Naine of Lictivied Plzmfbe-T; —'S'TL--3jC- 6AL-if-A !a K ljisurpacv,','.'oYq indicate tht: type of insurance coverage by checking the appropriate klx: _— Wit -F insur-aice pwifi,cyL Other type of indernnity Bond J- 11 i 11 Insura.iwe WaWg: 1. the undenitgned, have tie: en made aware. that the licensee of this application does not have any one of the above Owner n,Jill, best "If, ,LYkr10NVz j gc �t ic,�( qdihat ail. plumbing work and inst org cou"phance will: all pertincilt pr-OV'sions of the Mass achuseasji67el By: SlgnatM7 Agent 11 eove application air. true and accurate to the en . ,�Zt Issued for this application will be in -hapter 142 of the General Laws. Type Plumbing Licence C>3 4 dt'cZ ITIVer Master Journeyman 0 A. P P IRC) V.F, 'D F ON 1- . . . . . . . . . . . . . . err rrir�rrrr 0 OWN M rer�n�rrrorr�rrMrr�rMMMINrrrrr nrr Mrrmrriommrrrrrrr - ---------- M M �rmmmrrrrrrrrrr 11�11wfflmwmti F Check one: k Certificate C-0(iii-1-0111y Namo. C.t 1-'r` c Corp. 0 Addnets} 7-35�j W. 7, 1 7-1 --1 1 z , 4A Naine of Lictivied Plzmfbe-T; —'S'TL--3jC- 6AL-if-A !a K ljisurpacv,','.'oYq indicate tht: type of insurance coverage by checking the appropriate klx: _— Wit -F insur-aice pwifi,cyL Other type of indernnity Bond J- 11 i 11 Insura.iwe WaWg: 1. the undenitgned, have tie: en made aware. that the licensee of this application does not have any one of the above Owner n,Jill, best "If, ,LYkr10NVz j gc �t ic,�( qdihat ail. plumbing work and inst org cou"phance will: all pertincilt pr-OV'sions of the Mass achuseasji67el By: SlgnatM7 Agent 11 eove application air. true and accurate to the en . ,�Zt Issued for this application will be in -hapter 142 of the General Laws. Type Plumbing Licence C>3 4 dt'cZ ITIVer Master Journeyman 0 A. P P IRC) V.F, 'D F ON 1- I PO oJf F *;• 0 A � � F+M V � � Z pq Or+° H c y; hMo.L .- N d 0.a �ou V O In � z 0 Z � U H� gj � Cl) = ig OLL v w� 0 Z IU6 Q U O O� �, T W Z CA OZ a o � W � W � o V w a a I oJf F *;• s A � � F+M d � pq Or+° H c y; hMo.L .- N d I A � d � pq N d � �ou � z 3 � U � r6 O� CA OZ a � W U Qn �' w w W- I r� Z O O 1 W WO 40 tN\ 'ACO c s O i N O c Cc O C00. cl6 cccc CF -ONO: K O�1 0 0 �4 o 'm 3 y _.N N C c O O :�•E c R CLU L N •� O: CL Q0.0 Lc : V rig 0 a— O 10 tiJ �. cm c � m N c 42 •O =~ m � r=te ® N 43 LJJ WH� .co �, O * N •® O T t a O CD_ O CD c V)CL _ ®.- O.O O C4 w a w � Sco v . U) V) 'ACO c s O i N O c Cc O C00. cl6 cccc CF -ONO: K O�1 0 0 �4 o 'm 3 y _.N N C c O O :�•E c R CLU L N •� O: CL Q0.0 Lc : V rig 0 a— z 0 w W ,-,r p 2 U I Cg_ CO) O � � m Cn 0 CD O �co � ® Q _cc A d O � c CID vCL J .fl O C Z'5 C.3 CO) O C m CLh ca C U) CO ccW W W U] cm c � m N c 42 •O =~ m � r=te ® N 43 LJJ OdoC .co �, O * N •® C R a ®•N '0 OLLI CD_ O CD c V)CL _ ®.- O.O O C4 p z 0 w W ,-,r p 2 U I Cg_ CO) O � � m Cn 0 CD O �co � ® Q _cc A d O � c CID vCL J .fl O C Z'5 C.3 CO) O C m CLh ca C U) CO ccW W W U] Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9515 Fax (978) 688-9542 O L '[O[NI[M. MKM �9SSAc NUSti��� ADDRESS t'I e r LOT NUMBER SUBDIVISION DATE REQUEST MED ',5 DATE READY FO� INSPECTION �51 9/0'3 FIVE 5 DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED I ALL WORK AID SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- SPECTION FEE OF TWENTY-FIVE ($25.) DOLL RS WILL BE CHARGED IF STRUCTURE DOES NOT MEET ALL APPLIC A DLE CODES. SIGNATURE OFFICIAL USE ONLY *********************************************************************** ROUTING CONSERVATI N DATE PLANNING DATE D.P.W. — WA ME DATE D.P.W. MUST I&�D__ICATE THAT THE WATER METER HAS BEEN INSTALLED P OR TO THE INSPEC N REQUEST DATE. r S GNATURE / OPW AUTHORIZAT