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Miscellaneous - 45 BUCKINGHAM ROAD 4/30/2018
' 45 BUCKINGHAM ROAD 2101015.0-0016-0000.0 '- f i i N i I 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed 1i on the prescribed forin.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.GI c. 166,§32,an i3 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 maybe_deemed-by-the.Inspector_of-Wires abandoned.and_irrvalidaf 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 eriod beginning on August 15,2008 and extendingthrough August 15,2012. i w ule —Permit(Date Closed —�2--,O—/ ***Note:Reapply for new permit 0 Permit Extension Act—Permit/Date Closed: �.. ._. ,�•s�.,, .'i�iF-'��..J� -.r. fir;:-.. a"._ '"",:',r n i, 0 n f� U Date......�:.5 / ................. N f NORTH 3ro� `.o{6-1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� This certifies that ...................�/..�1.(//�hL/ f/ ..... :. T 2:.. ..... .6 has permission to perform ........ /...: ...... . ............................ wiring in the building of........ 1if!, Lr 'yi.................. ,North Andover,Mass. Fee.10iso 0..-"""Lic.No.. .412. RICAL INSPECT@iR ~ CYIeck # f `7 - t.omn:onweaX o/!/lay tac" official Use Only Permit No. L©6 5 0 eUaParfinent o f.tire serrric�ss Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ptm11 o7] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK chusetts Electrical Code C 527 CMR 1200 rmed in accordance wish the Massa , All work to be perfo _ � ) (PLEASE PRINT ININK OR TPPEALL INFORMATION} Date: 10 / City or Towns ok A �I N O o U e,R. 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) )60.6. Owner or Tenant A,- /'f° N V Telephone No. Owner's Address 4L Isthis permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Bog) Purpose of BuildingUtility 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 f /Location and Nature of'Proposed Electrical Work: Qe -r S'6 /Jye- 7_0 6U VII RC e"I(J42Y 7D [ l�, S�.T �e./� ocrl�C-• Co etion O'lhefollowing table EM be waived by the LWdor of Wires. No.of Recessed Luminaires Na of CeiL-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Na of Luminaires Swimmin Pool Above ❑ ❑ o.o mergency g g d. d. Batte Units i ^- Na of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones and No.of Switches No.of Gas Burners a of eteng D vi Initiatin Devices Na of Ranges No.of Air Cond. To No.of Alerting Devices Heat in No'.of Seff-C�n_bfted Na of Waste Disposers Totalsp um er ons Detection/Alerfing Devices No.of Dishwashers Space/Area Heating KW Local❑ Connecph'bn ❑ Other No.of Dryers Heating Appliances ICW Security Systems: �T No.of eviees or Equivalent No.of Water .KW o.o o.o Data Heaters signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommunications _ringg• H?' g No.of Devices or E uivalent OTHER: Attach adthtionat detail if desired or as required by the Inspector of Wires Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless 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: INSURANCEIN BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete FIRMNAME:Buddy Electric Inc. LIC.N0.: 12017 A Licensee: Vincent B. Landers J r Signature Uq-;r-4 / _ /_ LIC.NO.: 23 684 E (Ifapplieabk enter`exempt"in the license nimtber line.) Bus.TeL No.,. 9 t b e e 14 5 5 Address: 24 (1olga.te l)r N..Andoyer, Ma- o1845 AIL TeLNo.: *Per MGL.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 requiremeriL I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. P2?R1VI17�FEE: The Commonwealth of Massachusetts hY e. S Department of Industrial Accidents Office of Investigations 600 Washington Street 4 w Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): 13 L ZS/� )' 1rC- /,l C Address: G— City/State/Zip: r— Phone#: Are you an employer?Check the appropriate box: general contractor and I Type of project(required): 1.� I am a employer with� 4. ❑ I am a_ 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 g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp.insurance.l required.] 5. E] 10.We are a corporation and its ❑Electrical repairs or additions %3.0 I am a homeowner doing all work officers have exercised their I L❑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 13.❑ Other employees. [No workers' comp.insurance required.] - _,,• 1 *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. lContractors 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 6 an employer that is providing workers'compensation insurancefor niy employees Below is thepolicy and joh site information. / F Insurance Company Name: f'v? Policy#or Self-ins.Lic.#: PQ -3 Expiration Da ( _ Job Site Address!f > : 2 City/State/Zip: 24,0U—r '� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirationdate)P�15 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 hereby�clert�ifyy under the pains and penalties of perjury that the information provided aboveistrue and correct Sipmature:X/�� W /'A Date: Phone#: 9)F Offwial use only. Do not write in this area,to be conWietedby cnY 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#: / Date.. .R. . �.`.�l .. . .... . H°RrH TOWN OF NORTH ANDOVER t - PERMIT FOR GAS INSTALLATION y ♦ f � i • a �7SSACMUSE� '3 l6 1 This certifies that . . . . ! "t:'t . . j(:;-;y R:(LA:t . . . . . . . . . has permission for gas installation . .(IA in the buildings of . . . ��. . . . . . . . . . . . . . 0 at V. .,�North Andover, Mass. Fee. Lic. No.. .b. . . . . /. rCa,�, GAS INSPECTOR Check# 1 7-n i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: '� t t�/ MA. Date: �� Permit# Building Location: 1�7c'�'I�� Owners Name Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement-- / - Plans Submitted: Yes❑ No❑ FIXTURES co W W rn w W Q fn N 0. x NR' m = O W W L) N _ iii O Z z 0 W Q-' W 0 F- n Lu CO) Lu F- W W � NUWW � _Z � = No WW16- o U. Z W W z (A .JJ 1- F- O z -1 0 LL N x W W W W } N — Q W I— � z W M O z O m � Z F- x t0.1 0 0 = x O a0 W > > > O SUB BSMT. BASEMENT 1 F.-00R 2 FLOOR 3 FLOOR 4FHFLOOR 5 FLOOR t 6 1H FLOOR y 7 UH FLOOR 8 FLOOR Installing Company Name: Check One Only Certificate# �� ✓Cti e-e— St -CorporationS Z Address: City/Town: ate: ❑Partnershi Business Tel: p �� Fax: 9 7dr3�-�� 1 ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142zy-es�..Nom❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. l 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 Signature of Owner or Owner's Agent Owner ❑ 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 p ormed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Cod nd Chapter 142 a General Laws. TyjPWbf License:By lumber Fitter Sir ture o ' ense lumber/ s Fitter Title ❑Mast er Cityrrown ❑Journeyman License Number: (� tc APPROVED OFFICE USE ONLY El LP Installer I 05/19/2000 17:44 FAX igjvvc/vVj BOARD _�%�;�;.;�M� �'r` 'w,,�••; 4 IW U S-ER AND-C-11 IMPORTANT NOTICE PL LICENSE11 D AS A MASTER PLUMBER PERMITS FOR PLUMBING AND OAS FITTING INSTALLATIONS ON STATE OWNED OR USED FACILITIEs MUST BE FILED AT THE TYPE TIMOTHY CAFFNY OFFICE OF THE STATE BOARD. —M 15 COLGATE DR NORTH ANDOVER MA 01845-1606 754049 9067 05/01/12 754049 f s I Date.. .�r........ HORTM F A TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION - • ° a 'ISS us This certifies that . . . ✓t?tii. . , , , , c ?�1`�=�!'1.�. . has permission for gas installati/ln . . . . . . .fes. . . . . . in the buildings of . } .f a �. . . . . at �{S. . . f`.I/ ,. /219( . . . .. N h An over, Masi FIA—)I-CI-xi. . Lic. No:.? . . . . . . . . -77,x, . GASINSPECTOR Check# , f' k" �r r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: No - �944, • MA. Date: � � /itPermit# b / r Building Location: ,/u-��,.j+�ra,�/!d{1.yj _Q1— Owners Name: Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional ❑ Residential . i New: ❑ Alteration: ❑ Renovation: ❑ Replacement''6 , Plans Submitted: Yes❑ NDA FIXTURES co co 4, w w ~ cn N v = W ,' fYF- i In = O W w L) (n � O = ac W Z 1. Q Z ••1 w W Z W O 0 1- � O Z W pp p H w p Q CO) > w Z ag I_ Q IL t- W w x_ w �- W a w Cl) W z g3 -1a cn = w � w I- o u. Z W >- w � J Q Q m W O Z O I-- F W I— FW- W O Q W W > O O W Z Z W Q I- s o v_ c� c� x x g O IL w > > O SUB BSMT. -- BASEMENT '- -f ASEMENT1 sT FLOOR -7- 2Nu FLOOR 3 FLOOR 41HFLOOR 5TH FLOOR VF FLOOR 71HFLOOR 81HFLOOR / Check One Only Certificate# Installing Company Name: �.�`2 .a�� � ��`? [ _ � ET-corporation� eJl� Address 'V'-City/Town: state: El ❑Partnership Business Tel:'-t m. -:�'ls "'//3! /.'•i, Fax: _�!� e�r(,`� "'��1 �� E ❑Firm/Company Name of Licensed Plumber/Gas Fitter:— 6 c,:.� -� y�. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YesAa'No❑ If you have checked Yes,please indicate 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 Signature of Owner or Owner's Agent Owner ❑ 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Codpland Chapter 142 of the General Laws. Typ%of License: By lumber Xure ,•�Gr�aas FitterTitle 'llllasterSigicensed Plumbrer/Gas Fitter Cityrrown Lijourneyman License Number: �G APPROVED OFFICE USE ONLY ❑ LP Installer r Date. S� 1l. . . . r 958 gORTh TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING + a Z. �l +O++no•A`�4y ,SsgCMUSE� J r This certifies that . . . J. . l f r has permission to perform : t plumbing in the buildings c . . ✓ . .��!f. j.� /� ' J L f . .' t:f" 7' at . .7.5. . . . f�. C//.<. ?�. . . . �l fir/ �qq• ,i , North;Andover., Fee.37 S .Lic. No. Check # v PLUMBING INSPECTOR C/ 43 cl MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: 0 ,MA. Date: g `5 Permit# Building Location: �� t�l�t Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation:❑ Replacement. Plans Submitted: Yes El FIXTURES 1� DEDICATED 2 SYSTEMS W W j Y O � z H H N a. Wz z IIQ Y Q y ��'.I U IN- W O C 0In j m N Kvf C rW., in } W Q N h Z N H W W LL 1•- a N K a W O O W Z W Z U a. 2 J Q a C U t- a O U O a O a Y Z 0 rW.. W W � O W � W a m m o o LL = Y g 3 _ ° a a ' 8- -SUB BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4'FLOOR 5T"FLOOR 6T"FLOOR 7'FLOOR 8'FLOOR Installing Company/Name:�<� Check One Only Certificate# Address: rorporation City/Town: ✓��CSxate:��'�' �. ❑Partnership Business Te 1 � j Fax: ;�j�� �© D ❑Firm/Company Name of Licensed Plumb INSURANCE COVERAGE: I have a current Iia_ bility insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 No❑ If you have checked Yes,please indicate the.type of covera e b checking the g y g appropriate box below: A liability insurance policy 5Z_ 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 Si nature of Owner or Owner's Agent Owner ❑ 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 the General Laws. i By Type of License: Title ❑ umber Si ture of cens Plumb r P City/Town ter APPROVED OFFICE USE ONLY) Journeyman License Number: D I I i .. .....,`. - -. .. ..-:..-.�•..*'.^s:.�.:�1�'."e„`.�'.y�"y�•'�asan�;+"�.t+"M�'R�--�'s.1T '.+-am`+`-��..r'...•-,,,..-m�+�+,,,....,.�aay..,r.E.�t��,.a.. Location --11 ( ' � No. f Date �NpRTiy TOWN OF NORTH ANDOVER F w 40 9 F i Certificate of Occupancy $ f) 9 Buildin /Frame Permit Fee $ s�cMusE Foundation Permit Fee $ f Other Permit Fee $ - � �— TOTAL i Check # 1 17679 gUiiding Inspec ; PERMITNUMBER: TOWN OF NORTH ANDOVER BUILDING DEPARTMENT TO CONSTRUCT REP RENOVAT OR DEMOLISHFAMILY DWELLING &' . DATE ISSUED: m SIGNATURE: L z _ Building Commission7CE" tor of Buildings Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Maand Parcel Number: O Lx cr1 Map umber Parcel Number 1.3 Zoning Information: 1.4 Property Dim®sions: Zonin District Pr osed 1Jse LA Area 1.6 BUILDING SETBACKS ft FC0"te ft Front Yard Side Yard R pry Rear Yard Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 34) I.S. Flood Zone Info®ation: 1.8 Sew v Public ❑ Private ❑ Zone Outside Flood Zone ❑ e Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AU1gORIZED AGENT . rn 2.1 Owner of Record Name(Print) _ Address for Service. r g nat , re Telephone O 2.2 weer of Record: � Name Print Address for Service: O Signature z Tel hone SUCTION 3-CONSTRUCTION SERVICES mM 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Numbe __ Address Signature Telephone Expiration Date _ 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name _ Registration Number m Address a r" Signature Tel hone Expiration Date z SECTION 4-WORKERS COMPENSATION(KG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result a in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work(check sll a cable New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of D D Construction 3 Plumbing Building Permit fee(a)x(b) �. 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR S2nTACTOR S FOR BUILDING PERMIT 7 1, as Owner/Authorized Agent of subject property Hereby au orize - to act on My beha f,in m 'f-e ~e to rk authorized by this build'n it a licatio�_,-. g SiplawfQ4jr Date SECT16N 7b OWNER/AUTHORIZED AGENT DECLARATION ,as Owner/Authorized Agent of subject property- Hereby dec t the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO. O TORIES SIZE BASEME OR SLAB RD SIZE OF FLOG ERS 1 2 3 SPAN DMIENSIONS OF SILLS DINIENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t tj t 3 t"0V N l L tf A-) 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** `.` APPLICANT QIDU OCUj'1 PHONE__1' LOCATION: Assessor's Map Number PARCEL SttBDTVISION Plg4 ���� LOT (S) STREET(64 l IJ. M ST. NUMBER RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS q 4141tG PUBLIC WORKS -SEWERMATER CONNECTIONS f / DRIVEWAY PERMITlav / /FIRE DEPARTMENT ��( l°e/yn f 9c9olie4 RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. /"0C�- ��Y°�se Type of Work: o"ne4&iM n 6Ce Lme1 Est. Cost- Address of Works "7g/I Owner Name: Date of Permit Application: C�D hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: I.hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permi� the owner oj_the above property: Date Owne ,Name --` a L NORTH ONM Of . 4Andover No. MY - _ dower, Mass., —off d—o?00 COC NIC NE WICK 5 V 7,9RATE D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT I.,? ..............m.��'aAIIV D P%............ Foundation has permission to aM.. .. .!4.� b G............. buildin s on S �vQ N g .......... �...4• ...... � � Rough .......... .................... ..... to be occupied as e ��S� N O h t *O c / v N p ....... ...................... N_.R... '......IG.............. d..... �� � Chimney provided that the person acceptin1this permit shall in every respect conform to the terms of thea lici t on on file in this office, and to the provisions of the Codes an By-Laws relatin to the Inspection, Alterat'on p d Construction of Final Buildings in the Town of North Andover. w r� S N 16 ire V N &4#04 j S PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. �� I I go +s Rough PERMIT EXPIRES IN 6 MONTHS '�// Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION QST TS Rough ...... .. ........... .. ......... ./....»..'.. ........ Service BUILDING INSPECTOR Final 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 Street No. r� a SEE REVERSE SIDE Smoke Det. w 1 STONE BOUND r- FOUND - c 0 O PLAN OF LAND NAIL LOCATION N 8300010311 E PAVEMENT NORTH ANDOVER, MA 3/8^IRON 93.43' PIN DRAWN FOR 21• DIANE M. DEKOW - ASSESSORS MAP 15 z PARCEL 16 2a SCALE: 1"= 20' DATE: OCTOBER 11, 2000 REV., 1/11/2001 w � L.C. 7A o, zo' ao' a �e 60' 00 x AREA=7,373 sf r' uLA 00 b o M 2.5 0 SCOTT L. GII.ES P .L.S. _ FRANK S. GILES PROP. U 25 NORTH AN 7, cx 22' DOVER, MA "3/8^IRON (978) 683-2645 3/8"IRON PIN PIN � � - S 77029'30"W12.26' 10 POOL WOODEN O FORD REFERFN FS• ., PosTFND. L.C. DEED BOOK 91,PAGE 325 aoo w , $ LANDCOURTPLAN 8813T LOT 7A w w_ o $p'Sfi ASSESSORS MAP 15 PARCEL 16 ,14041'4'!"W �N * The front setbacks shown are greater than the average r STONE BOUND setbacks or 250-feet on either side 3/8"IRON FOUND for a Of the locus. PIN 1 k *EXISTING BUILDING FOUNDATION TO BE RE-CONSTRUCTED AND A LARGER DECK ADDITION TO THE REAR OF THE BUILDING. I% or S n SCOTT L.GILES,P.L S. �. 3972 oct psi TERI BRNA#45.DRG ! ! Zoe LANO g�4 DATE 59U6 l 17 Date...... / a .. E ' TOWN OF NORTH ANDOVER PERMIT FOR WIRING as SSACHUS� i, This certifies that ..... ................................... t has permission to perform ... 'r v.t e- f--.......UY01v A....u::.......... C C �,v�r wiring in the building of............... ...v........................................................... at..... a 1'��f ''Lul................. .North Andover,Mass. .................. ........ .... . ........... 4 -- 3509yE �r AQP Fee......•?`........... Lic.No. ......... ... ... €.. Z ELEcrRICAL�INSPECTOR €' Check # h DEPARrMENKSAMY Permit No. � BO4RDOFF=PRL'wymNREICULA?TONS527aiR12v Occupancy&Fee Checked APPUCAHON FOR PERMIT TO PEMFORM ELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,52,ZCMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date AW Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) )(-' YV\ Owner or Tenant C; Owner's Address Is this permit in conjunction with a building permit: Yes No [:3 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps 0 /NOVolts Overhead ® Underground Im No.of Meters New Service ZMO Amps 21) Volts Overhead Underground Im No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tuba No.of Transformers Total KVA No.of lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burner No.of Emergency Lighting Battery Units No.of Switch Outlets No.of an Burner No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Toru No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Device No.of Dishwasher Space Area Heating KW No.of Sounding Device No.of Self Contained Detection/Sounding Devices _ No.of Dryers Heating Device KW Local Municipal 0 0 Connections No.of Water Heaters KW No.of No.of signs Ball" No.Hydro Massage Tubs No.of Motor Total HP OTHER s> Ptrts�ntblheafMacaed>m�GataalLawa L tr cribs eldit"lmt YES p NO ItNm&br4dvaTidpodcfs=lD* Offi=M ff}wharedm*:dYFiS„pk=itdr* tetXiecfarn�by dmadQglhe L... bac J D61RANM BM OI1r1FR raw** . 8#mdcnDme EstimeladVatmeefE1%2 calWadc$ kzp0mDa1eFqzskd RaoFind FmmNAME LicaveNo, L;taeae 1 - Lkmm m C —�- BttsilessTdNa •��' !V 6 ALTdNa �—Q OWMCSIlVSURANCEWAIVfR;Ixnmm mttheLmwdomnot limmmurcoyaWarilssarrialqivaktasa3WWbyMmdumG=WLaws ardthetnp+sgnumatttaspeur>tIRAN tiQtwai�ea�raclt>mrr�t (Please check one) Owner Agent 1:3 Telephone No. ��s t PERMIT FEES DENUMWOFPUBUCSONY Permit No. ,7 f BQARDOFF/REEPREvfff oivRFaGiAAT1YM5270MLLO Occupancy&Fees Checked A.PPLICATTONFOR PERMIT71O PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PR.Dd'IN INK OR TYPE ALL RMRMATION) Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street tit Number) � Owner or Tenant EiPA 9W ' Owner's Address is this permit in conjunction with a building permit: Yes No C3 (Check Appropriate Box), Purpose of Building Utility Authorization No. Existing Service f00 Amps tJ /A Ovolts Overhead ® UndergroundM No.of Meters j New Service 7Q-t0 AmpsLL / 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 zround 171 ground ri —9.—,f Receptacle Outlets No.of OU Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of tau Boman No.of Ranges No.of Air Conti. TOW FIRE ALARMS No.of Zones Tom No.of Heat Total TOW No.of Detection aw No.of Disposals Pumps Tom KW Initiating Device No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Device No.of Dryers Hating Devices KW I.ccalMunicipal O a Connection No.of water Heaters KW No.of O.of _ No.Hydro Massage Tuba No.of Motors Total HP OTHER' Irtstmrot;C PlrtsnarYbderac)u�rrn�afMi�adsiselhCsr®1L�g Iha�eaaaaYLitfiTtylr�tasraeR�iCj'iri�drBt7arnple� arm srielot}ivaist yES Ihavesu6rrittladvaidp�afafsamebfiet Y$S g'yauharedodBdYflS,Pkmn catedetypecfamWby dub tgthebot, 11........11 1r1,URANCE BOM MM � �fmseSpe� EstQt�dVatleafE�Wady$ WoMoStat >ibpachrslDaleRor}nsied Ra* Fkd 1TftMNAIv1E M &ld=T>dNa 4KINSOh D � io�ise eniumne � ALTaiNa SMJRANCEWAM3klanmmtabL�� thetmysigtiatr�emthispmntapplcat�wanesQlistegiier>at °D� °q`tivalaiffiteq"�dbyNl�dli�ethe3a,aaiLawa Please check one) Owner Agent13 j Telephone No. PERIVIIT FEES %'L� �. r ���c. (��� G',�i�Gc� �N oR /w f�.s 6 2 � � 0� C Aft 1 enCam DEC 9 INCORPORATED b i December 17, 2002 Ms. Diane O'Connor 45 Buckingham Road N. Andover, MA 01845 RE: 45 Buckingham Road Kitchen, Hallway, Utility Rooms Dear Ms. O'Connor: This letter is to inform you that notifications have been sent out to all necessary regulatory agencies concerning the asbestos abatement work to be performed at the above captioned job location. Regulations require notification of intent to work at least ten working days prior to the start of work. The notifications for this work were sent out on December 17, 2002. We plan to commence work at the above captioned job location on January 2"d, 200. Enclosed please find a copy of Commonwealth of Massachusetts -Asbestos Notification Form ANF-001. I will be in touch with you prior to this date to confirm our arrival. If you have any questions regarding this matter, please do not hesitate to contact me at your convenience at 878-883-7787. Sincerely, Patrick . Sennott President PJS/JR cc. North Andover Health Department 145 Marston Street, Lawrence, MA 01841 Telephone: (978)683-7767•FAX: (978)688-9998 e-mail:sencam@netway.com r•- - r " c�'ornnauilwealtl� of Massachusetts �� r. �� Asb�s#os Notificafiioti. r `x '`�EX E mp Form -- F-U01 I a '� r �7� Asbestos AGalemerU Description d �tit�"f5 '^ Facility location: _ Residential irstnucrtuns Name' ...............................:_................................: . 5_ Buckingham Road Address _.................................................... _.-. sections of this Ionil. ...... ,MA 01845 )c cotttinlcled in order City/!own ..,_..................._........,:_.... ............... ..7...8..-..725..-.52,3..9......................_. . zip code iply with Ino � �. telephone .. ..........._.._._............__............ r11110111 of -- �hen�Jiallwa utilit rooms What is 1116 norksile•localion7 building name,/,.rt_l oar,room ��-- __ unrttanlal coon notification ?, Is the facility:occupied? bd Yes O No — �ntenls of 310 GMfl � . ;ten wofkllt days 3.. Asbestos Contractor: lUllflcal1Ul11S• • °dolanyabalemenl SenCarn, Tnco.r ora) e.d /);andute . �„_•; _ 145 <Marston Street rlmohl of Labor' Name —.- _— utusirlo.a Address Lawrence, MA alionrequirentenlsor _ 01841 978.-633-7767 MR 6.12 (len days Cl(l/ronn. Zip cavo ioliftcaliou is te1ep1101)6 VVIANYabatern it AC, 000129 -................................. Written i greater than!hive DLlLicense .......... .. . or square leelj, Contract Type(written/verbalJ ............................__.._.....__--..__..... 4, On-Site Project Supervisor/Foreman: nnil Original Donn • ..__...__.P.ablsz I�Iurt<.�.�_ nionwealtlr of Name ------------ DLI Cerrllicaliat/ sachusetts . 5, Project Monitor: ,stos Program Box 12 0 0 0 7 _--.._...... F11V71 4nm�n 1=s� .__.�I �t lt. i _.._..__..._._......_ . _��_. nil, MA Nanne AA_._00.�2_Q.4.4_._..._.__-...... ULLCerlificalionf.' "- --�- ;t-0007 6, Asbestos Analytical Lab: 3iornt.maybeusw Envitonmetal Health Inc.. __..__..___......_._..._..__.___.__.__..AA X000044_.._..—_...._�._..__._._._.-_. flying-tile U.S. Nan16 omental Protection . DLl Certiflcalion/. Region l of 7, 'project start date LLL 94t)ddale � is demolillon/ 03specific work flours(Mon.-Fri.)7AM-4PM (Sat,Sun.) lion operations to NLSIiAPS(40 3: What type of project is this? (circle one): demolition repair renovation ollrer(explainJ ibparl M). jaidssryiiYt 9. Describe the asbestos abatement proceduresto be'usedd (circle): glove bag enclosure lullconlainrnentcleanup g encapsulation disposal ovl p Y other(explain). 10, Is the job being conducted ®indoors ❑outdoors 7 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) or other. U)r1fUL�/4�G��W+s'y xs a; rr.z3 is x surfaces(square it.) 300 to be removed, enclosed or encapsulated: s� ? linear/square feet boiler,Ureaching,duct,lank surface Coalffngs;.,T/ fltemlal,solid core pipe insulation corrugated or layered paper pipe insulation. ,. —J insulaling cement,,,,,,,,,,,,,, , .. spray-on fireproofing.,, ,,,,,,,,,,;,,,,,, _/ trowel/sprayer coatings.......,....... clolhs,woven fabrics........... ..•...... ^/ transile boarQ Wall board'.... other(please describe).................... --/ 12. Describe the decontamination systeni(s)to be used: Full containment conditions 13.. Describe the conilainerization/disposal methods to comply will)310 CMR 7.15 and 453 CMR 6.14(2)(8): ., . _All waste will be adequately wetted double .wrappp ] ;n 6... 1 —I.o-y-, transported and cli Spo.. e l of at an EPa_--aA$roved landfill 14. For Emergency Asbestos Abatement Operations,the DEN and DLI officials who evaluated the emergency: _ N/A Name of DEROlflelal',. 11116 -' Dale of Aulhorizallon Waiver Name of Al Official title Dale of Authorization Narver -----•-�___....._._..�___.____________.._.•.. . / 15., Do.prevailing wage rales apply as per M.G.L.c, 149,§26, 27,or 27A-F to this project? � Yes No 1'1CV•8/99 aClllty DP.SCrlptlon 1. Current or'prior.tise of facility: 2, Is the facliity owner-occupied residential with 4 uriltsortess? V Yes ❑ No 3. Facility Owner: __.Di ansa O'Connor 45 Buckingham Road Name Adrliess — -- NDX-th Andover, AA 01845 978-725-5239 Cily/Tou — Zlp rode Telephone -- -- --- 4•, Facility's Owner's On-Site Manager: Diane O'Connor 45• Buckingham Road . Name Address — " — Cily%frnvn . ....,: .•.•• . . e . -..........Nor.th. Andover., .MA...........:.0 -725-52 39...•......................................_.•......... 978 ............•• _ ._................:. Zip rode Telephone 5, General Contractor; ..........N/A.-_............................. ................................ Name ...............:.............................................................._.. • Address ............_..................:.:..:... ...........................................................................................................................•: ................................... ............._.........................................,_.... Cily/Tnwn ......................................: Zlp curie ...................._._........:................... Telephone Conlrar"lor's Workers Comp.Insurer Pnliyi •Crp.Dale 6, What is the size of the facility? of floors) r Asbestns Transportation and Disposal 1, Transporter of asbestos-containing waste material from site to temporary storage site(If necessary)to final(lisposai site; SeTiCam, Inc. 1r�5 arst on Street ................ ............................................................ Name ' ...................................,......................_. • Address :................._....................................... Lawrence, MA 01II41 078-6II3-7767 CityfTr tvn ZIP rode ..........,.__.........__._.....__.._......_.__. Telephone .•••.__..._.._._.:... 2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal' te: Ej _—_--- ' 10 Burnham l . — e _......... ...._ ...____._._...._.._...-__...... .... Address _ Sc!a�bo.ruugh ME— 04074 _..._ 207..,.._83-5682 Nate:Transfer ' ciry/Tmvn - •.'—_ �__:..___.._.....�_._..__.._.:.____..__.�...._. _._. Fr Zlp rode .............._.. Stations mllSt Telephone " comply with the 3 Refuse transfer station and-owner(if applicable): Solid Waste N Division re0ula- Name tlons 310 CMR Address ---- 18.00 Cily/Tman Zlp rode Telephone l!. Final Disposal Site: . - 14 nerva Landfill: Lorallon Name --- Owners Name — ---. 9000 Minerva Roar. ...:: _ Address _. Waynesburg, :Ohio 446Bf3 330-866-3435 ___._.. Clp/rown Zp role Telephone -----— -- Certification _ The undersigned herepy states,underthepenalties of perjury,that he/she has read the Commonwealth of Massa,husetts Re ulatio? for the Removal,Containment or Encapsulatlon of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the Information contained in this notification is•true anis correct to the best of his/her knowledge and belief. Patrick J_ Sennott Pilnl Name .............................................. ea ..:.... .YS ........ 12—17—02 Note:Contractor Aulhn"died Slgnalure most sign this• � Dale ....................... 0 VP Operations SenCam, Inc. formfor DL ............................................. , PosilioNTille ................................... .......:....,........................... notification ..............:....................... 97£3, 6II3-7767 Itepresenling Telephone ................ purposes 145 Marston S.trreet Lawrence, MA Address • .............................................................................................:..:.................. ...:,..••....,.,........:._.:._.............,........:...........................:... rrly/rntvn - ap nude N6 exempt.(City,Town, district,'municipal housing authority;owner-occupied'residential.of four omits or less) ? es x, C Y no Sticker# (irnm front of form): E 76139.0 i • SenC • IINCORPORATED October 22, 2004 Ms. Diane O'Connor 'VED 45 Buckingham Road N. Andover, MA 01845 OCT 2 6 2004 RE: 45 Buckingham Road eH N NOR MENS R Bedrooms (2) - Bathroom Dear Ms. O'Connor: This letter is to inform you that notifications have been sent out to all necessary regulatory agencies concerning the asbestos abatement work to be performed at the above captioned job location. Regulations require notification of intent to work at least ten working days prior to the start of work. The notifications for this work were sent out on October 22, 2004. We plan to commence work at the above captioned job location November 4, 2004. Enclosed please find copy of Commonwealth of Massachusetts Asbestos Notification Form ANF-001. I will be in touch with you prior to this date to confirm our arrival. If you have any questions regarding this matter, please do not hesitate to contact me at your convenience at 978-683-7767. Sincerely, U �� 1 Patrick J. ennott President PJSIJR cc: N. Andover Health Department 145 Marston Street,Lawrence,MA 01841 Telephone: (978)683-7767•FAX: (978)688-9998 e-mail:sencam@netway.com _..... ....................... .__.................................... ._..................._........._..._.................... .............._.... ........_............. .._........._. ..........._._.................. ............ ..................................................................... ............................................................................................. ......................................................................................................... ........................................................................................................................................................................................... .. . .... ... ... . ..... ... _._..... _..... ...................................................... Commonwgatth of:Massachusetts:::::::.... . . . .... .... _ - .. .............. .. ... .s.•!riM.!®uPu..4anM1m+eumq^.R.:.•CCCP.J-9. :C ..... :........:.. . ... .. ... ... ... ..... ... ........0 ..a9 ............................... ............. r :.. . . :::::::::::::::::::::::: :: ::::::::::::: ::::: :::: 100(Y10610:::::::::: ::::: :: Mbestos:Ubtitrcatlon orrr ANF-t �1 Decal�Jumber: 3 ... ... .. .... - ... .... ... .... ......................... ........................... ........'................................................................................................................................................................... ............... ................................................................................ .......................................................................................................... ........................................................................................................................................................................................... ............................................................................................................................................................. ................. ........................................................................................................................................................................................... ............................................................................................................................................................................................ .......................................................................................................................................................................................... . ........................................................................................................................................................................................... ........................................................................................................................................................................................... ................................................................................................................................................................:.......................... ................................ :: : ':::. ... ........ ...... . .......... . . _,... ,..... . .:..When filhn :otd:::::A.. Asbestos:Abatei bent:Description : : ::::::::::::::::::::... ::::::::::: :::::::::: A ......................................................................... . . onns:ant e:::::::::' ::::: :: :::: ::::. : :::::: ::::: ::: :: ::;:::::::::::::.::::' : : :::::.::':::::::::::::::::::::: :::- �iiter,.use:::: :: a is this fabift.fee:exempt.;ctfy:,:town;district, municipal housirt8 auth6ti1y;:ovuner.-occupied . : : ..only the zab key'.. :: residence of four.units or less?L Yes :: No:: . .... .... .. .... . . .... ab,ftibb'e:your::::::: :::::::::::::::::::::::::: ::::::: ................ ....... ...... ......................:... .. ... .. ....... .. .. .. .. .. . cursor da nat b..Provide blanket decal number if a licable; PR Blankief•l3ecat �. ......... .--II.....um: ........ ... ...._............. .... .................. ...... . key:::::::: :::::: ......2;: :Fae.. Location R# SlDENTIAL = _ I43:BU:CKING:HAM:ROAD .. . .. ... �.. _ ;Yom '. ... a ..a.. o _ _ Nairne. a i. b. re s Add es I AND VER �fiA 01.. E . 4 (978):852-4328 Cocte:::::::::::#:Tele hone:Nu or::::'. .. _..............................................._..... ..... ...................................................._........................................_.......................... ........................................................................................................................................................................................... iN5T12UGrti: .::::.. :: . .Works..te..:ocation:::::::::::::::::::::: :::::::::::::::::::: :.................................. C)I�1S..........,,. .,....� y_ . . �.�. BEDROOMS:2:::::::::::::::::::::::::: ::::::::::::::::::: : :: ::::::::::::::::: : :: : :: : : :::':::::: ::: t3 ►T.HROOM::I::::::: a.Buildin Nam......... Locahan b Buildin t# .......... form nnast kie:::::::::.::.:..........0...............9.:.,::....:::::::::.:::......0..:::::::::::.:.....9:::::::::::::::.................... ::::::::::comp eted in.order:::::::::: :::::::::::::::::::::::::::::::::::::::::::.::w::::::::::::::::::::::::...... .......... ................::::::::::::::::::::: 4 :::is:thefacility:occupied?:::'a Yes:: :w:No::::::::::::::::: ::::::::::::::::::: ::::::::::::::: :: : :::: btP notification. . ........................... ... ..... .. r5AsbestoCntractor:o andthe Division::::::::: of.0aci�patioriat ISENCAM IN:C 145.MARSTON:STREET.. .. p _ .. .. .. ... .. .. .. ... .. .... .... ... SaE [ QG].. y8 _ b..dd sµ ata an:: r regiiirerr:Pofs af.453 LAWRENCE n1. 1841 X9786837767 . ^� QMR 6.1Z { Qty1Town d DR�Gode eph .. e.Tet .one Number'�� 777 #AC000129 .r ..................... g,.:Contras#hype, 11k/ritfen : Verbal "Cicense umber; _ IQIANE O'CONNOR _ �r ..,.,,�,�.,,,; pWtVER 7— " ,�. h.,FaciliLL�Coni ABLO A NI�NEz �'�1Ft ;fl►so3cts14 .. : B .; S x rmj P^!y ,v :. v,,...... : .. .,.,,,... ,,.. u ,�, .: a Name af: 3R:parte peroiso�(Foreir a:ri bu rvisor�Fo .......OEC et eahoat umlier ENVIRQTE:ST:LABORATORY: 000128:: _.... .... ....... 7'' :a.NameofProjectMonitor:: b;:PrUe L v� ct Monitor DOS Certi�catiott Numiier . ........... .......... ................. ...... ............ ............. . . .. .. ................ ....... ........ .. .:. M _ w ..� {:::: ........ .......::........................ ...... . ENVIROTEST LAWRATO) Y : AA000128 .. 8 1:.. a U of 1) sbes os i4na1 kal a " _ biAsbe.mp �lvticat dab OSS ert�icatiQ R4ber T 1�04� 004 �,, IllO4noa ..... � � a Project Start Hata mmiddlyrr�� b:.:End:Date mldd : . a.r1c hours..i;at.auFl. . ......... d :: . ... :::: : :: : .... .......... ::::: .............. ;..::..1.[ .....W. .... .. . :: -------------- 07 Qemrtolitio:n::::::: 1, $ Renovation:::::::::::: ... . 17 tie air: :Other: faas:e:s: :ci vw ...: b::Descrbe.:.... .... �,--..... ... ,,.,� p pe f- .. . ..... ................ .... ................................... . . ..................................................................................................................... _. ....._......_......................... ................................................................................_...................... ......... : ::.ec :a. ateme... p :::: ::::: ::::: :::::::: ::::::::::: ::::::::::::: ::::::::::::::: :: :: :::::: ..................... ...... ........ ................................................................................................................................................................. Move bag t=riclosure : ©i� osal oni. .. _.. . ..._.. _ . . _ ...... _... 1 11� C an e. (nth 'r s w cif A:: e. ... ................ ............ .. u I.coma inmen...... ............... ....': b:.:Descnbe....... :::::::........................................_.... . :.... . . ...... ... .......................................................... 12 Is the jab being conducted Indoors? Outdoors.? --....... Asbestos N�JottficatioaiForm•.Pag.:s.. ... ofi ........ ... ... P e 1 oE3 ......................................................... ................................ ........................................................................................... ......................... ................................................................................................. . .. ... ................................................................................................................................. . . ................ :::...::.V�!'ss ............................................................................................................................. OIJ.6mon.w .alth. IVII ......... „ ...;..::�:'.':. k .......... ... ....... ....... .................. ......................... ............. ..... . .. ..... .. ...... : � -1 . . ... ................ ...... .... .. .. ...... �, - ca umber; e #ast� �cttn FrmNQ01 . ................... . Asbestos Abat imeint ��scr� tion i✓ont: :: ::. P ... ... .. ......... ..._.................... ............................................................................................................................................................. . ................................. .............::::::: :: 1176tal:arr 6u'nt:of:each type of Asbestos:Containing Materials:ACM to:be:rerrioved; enclosed,:or::::::::: ........ . .......... .. �......). ... ...re . ......... .................... _..._......... ::::: :::end..s. .:::: :::::::.::::::.::.:::::.:.::::.:::::::::..::::.:.::..::.:::::::::::: ::::::::::::::::::. .. ... . .. . . .. . . ..0 3t}a to Fold os o"rc7ur�"s`�iinea� T Ono o�9e.surfaceyequa �s .. .. m.,,.. 7-1.... e:Boiler;breacttin ••duct •tanit . ... .... d..lnsul ... surtace•coafi s:: 9 .. Lith ,,.. q.:,. ,..... {n. S :•ft_• ... ..... ..... :a:. ........ ... .... .......... .... �,: P �.y l:' ..Gorru at_d orl e r a er .d: s . t: 9 y p� a: - oweU.Pr2yer c95atil�}S., s� ... :pipe..... tii?ri ...... Lin. �,:. _ 300` _.5 ra =on:fir roofi' ; . :: e n e 9 P h_:t an_ Y p r 9t,board,:wall board .�. tirY,,ff ¢F _ 9.. } d. ............... 77 i5t. F' ' t EI oth_ Wove{ r i fab acs .};ottir please specify:; :.f i j•t a .. k T 'r CE#LIN tis mal solid r Ca IxAN co a E: . t. InSUtatlbn:....... .. . �) :::::::::��I-:. ::::::::.. Spe�fy:::::: :: : :::::::: : :::::::::: .::::::::::::...... _............................... .:...:::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:::::::::::::::::::::::::::::::::::::::: ::' . ... a: �.:.P �.C FULL CQNTAII�M�PIT:` ... .�.. ..............................k....... 15 :: e: :::: ... . D r b� ........ .. ..... .......... ............................. ................. .............. ...... sc (....the:cv.rltainetizatlor)ldi$ptisal:methods:to complj�.:wh:3.10:CIVlR 6.1 (2 9 . . . . 1�1tASTE WETTED, DOUBLE:WRAPPED.IN 6:MIL POLYIEPA APPROVED LANDFILL..: _......::::::::::::::::::::::::::::::::::::::::::::..:::...:..:::::....:::..:'...::::.::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::: :::::::::::: : :1 ti FQr:E:rnergency:Asliestos:Opetatlet s;:the:QF slid.DaS:offic als:�n(ho:eval fated the timer et1 NIA w 1 . _.. . NaFl1e•al �Tiic9ai` �.1`it1`�""` c lJate mmtfdl af. 0{honzat9on �� f YyYX> .. d €Sl h 1117`a9ver# ....._. .. ..... . :. . .....: . ..... a: „..,;..1 9`' nn, M �m ».., . t ti Uifaraa{ I Rle .ate:mrri tlt ofult�ior9zabon: :: 9 .......�. yYYYa � �yf}�J�"�a9ver#f:. k.,,. . �.. . .. cv . . _ ............... ®o�u 17:'Do:preva.ilIng wage,rates as per M GL:.c I49, 5 26, 27 or 27A: :6 I to.this project?:E_j Yes f✓f N6 E �'acilit D.6s6f tion _W . w µ � h . .. ...: .:::::: :: : ::, : :: :::'::::::::: :::::: :::: ::::;......... Current 6r nor use of•fac{It w ,.,, µ� � - 4 �� �......w...... w. ................. . . . .. p:: ... . tY' a _. .. ...... .................................... ........................................ ........................................ ................ ..........................................._.......................................... . ..... ........ 2; : Is the fac{lity:owner�ccuped:residettttal:vvitfi 4:units or loss?: R�Yes: t No jDIANE Q CONNOR 45 BUCKING HAM.ROAD .3:::: a Faeilfty Owner Name Address a IN ANDOVER �Oa$4S � j978-852-;1328::::::::::::: n.� f o c 9tyffot^n rt dip.Cotte e ele hone Number area cods Wd extension ....... { ; �.. �.� ” 4 DIANE O-CONNOR „3 45 EUGKINt3HAM ROAD a�, 7. ... : In a Nastrie of FaG19ty Clwtict s Oh bite Manger b;CX9 SiteManacr Addr2sc W �w a N ANDOVERoaa4s -1 28 � .7. 77. OEM �. . d c Gityi own 1p.Cet�e e..Telephone tJumF�er.(area coW.:n et e siony:::: :.:.: ............................................ anf(1(Jia .doc+a07b�::: : :::::::::::: ........... ......::::::::: :::::: ::::::::::.:.:.:.::.::: P....... . Asbestos Notirication:Form•' Pa +�•2 . .... ................ ............ .............. ............................. ...................... ............ M d W .............. ............. ............ ..................... ............. .......................................................................... ............................................ ...................... q q ::::::::::::::: :-::: :: ::q:::::q :r:p::q ::q:::::::::::::::j:::::::::::::::::::::::::: :v 4:::I::::::::::::::::::::::::::::::::: :::::::: :d:q::::::::: ................... ......I........I.... ....... .......... ..................................:... ................... ......................... ...... .............................. I ..........1 .... .......................... ........... ...... ......... ........ ........ ................. ...... .......................................... ....... ................. ............ COMMOnw-a-alth'.0f Massachusefts .......:............................ .......... .................. ....... .........:............... .. ........... ...... 00 ............... ........... .. .... .1 .0.106 0::::�_...... ............. . Decal .......... At:bott6g�N6tifi:t.ati.oh:::F6t.t.n-:AN:F001: ........... ................... .................. ................ p q ............... .......... .............. q p F W .......... I .. ....... .... ........ ..... .............I.............. ................. ...........I ............. .............. ................ ......I...... .......... .........I......... ............I....... N/A: . ..... ... ...... ....... ... ..... ....................I ............ ....... .......... ................. a.:Name M General j77c—o7 .............Ib�:Address: ........... ......�....I........................I... ... . ... . i .. . .... ...... .... ........,..,.. ..... ..............I.............. Citifwon . e_:TelhonpNu�bR j;�code zn e . s:,. . ... ..................... ... ....p.................. . ....... . ...... ...... . . ...................I ...... .......... ....... ............ Go fid--m-R_p_rg 0: Dated............... T ..... .......... ..........I :J. .............. is the SIZO.:Of Ihi$J0011ity.?::-:*:::::: ............. ...... ...... .............. :NumbL,.r.of:flcyor!s:::::::::::::: ay. �L;j—r, ee ....... ...........b 77777� .......... ............. .............I ...... Q AS bf 6 S t 0 S: Mans- tllorftakio.n. :and Q*:�:::: ......... ........................:......... ......... ............... a:q�:::::q::::q:_::: �::q::.::F..1.1 . I I_Mposa .......... :......:...::............ ................:q::q: �::::::q::..................... ..................I...... ........ io:::........ ....... ............. ............. ............I.......I ...�:.... . lerafto it : t p ................. ............. t rory:siorago.: Ito ...... .. ... .................... ................ ...............:::�:: *:,: : :::::::: ....... ........................... ............ ri�W�A_W.INC. R'41"S"":—MARS—T 6 N7S�T"R_EEi,ii,77 77,7 7 7 i:77 7 7:,77 i 7i. i r LLi a TraiisfFr Note- :A Name:of Tr9rispotter b.Addr6gs: 101841: 1: 1(978):681.776T com 1 with the... ......... ::C*tT6wn::. d.Zi�.Cm Te'n.Y16ph npN rnbe.. ...... .le e- .6 Li r: 0- rVIISIOn2Trans-pc)-rter:6fi�sbest6§ c6ht�iihing,:wast6-material rcim i&6r�ov&IA6#0�6N*site A6 final�disppsaf site: . iRec3iitahanr 31.(1 : ......... ......... ...... CMR 19000 ....... IkED TEtHNOLOGIES.. p .. ... ... 5'FORESI PARK: ........ .......... ........... ................... ......... .......... MiNGTC ......... .......... s(860).67.4.4429'. s Grownct Zig Gode ... ............. =7. .... . .... ..... .. . N/A :: �:::::.:: . ............. ........ .... r. .Tele !!p Niiber:::::::: ........... .. ---VA---- A liMINER :8NT89PRISES:INC:::::::: DUFANO... ... ........ .......... ...... Final........Disposal SiteCOGt_iName b..:Final:Disposal Sde.Location.. -Owner s Name .......... IwOOMINERVA.:ROAD'::: 71:: ......... ............ _J [�_ f,::uBq!AlDrs qM Site:AA(fre8s 7=7777 :d.C;qjTO": 777 -= .. I,_..'. ............ r.7.... .................. ............ �OH: .... ... 14468 330111'866-3435 .... ... . ........... ZjO Code.:...: q_..Teiler'p-hone N u*rn 6;�. .......... q:q::::::q:::::::: :::::::.::::�.... .......... .................. .................... ........... �p �:::::::s: ............................................................... ................... M,cettificatio* 6 .... . .......... . ...... N .... The bfidiqrsigned:Wbb�.6tat6s, PA-TRI.CK'SENNOTT. Under.the V. ...... pe of perjury he/she has read:the::::: ..... . .. .................I............... Commonwealth of Mamchusetts: a t Commonwealth.. ..........Massachusetts, r gpla Ops I 10 for the:RemOVal :Containment ot .. ....... 1PRIESIDEN! ...... .... . _:: �--1 1.r......................... ................ Containment . .......... ....... 4p. ....... C. 0 1 ............. d::Date frnm/dd/W 7 Encapsulation Go.�knd ........................ ...... ��1(978)�683�7767-.:*.�:::::!::: 310,0MR1.16, and that the information........ ....:ISENCAM .IN contained in this notificationis true and COT' 00h NUMber e-Tel One MARS-ro ......... . .. to th6 b6i5t of his/h,q:k66wkAqO:aAd belief L N 8 TRIEV ip:: r ...q . ........ r: — as AFCW .......... .......... . ... ........... LAWRENCE .... 01841 . . .......... . .......... ... ................... .......... . ........ ........ ...... anf00Iop.dou00102::::::: ..... ...............�:p::o..:..a... Asbestos Natification:17arm:oRpg ...e 3 of ........ ............. ........... .. . . . . ........... ......... ....... . .:::::s:: ::�:�::-:::i:::i:: .......... ................ ...... L f Mike.Wallace product specialist . i THIS 777 ii l Fences i I SHOPP Locatio UNLIMITED SNC E (603)537-b555, ..(800)892-0456- -FAX(603)537-0557 '- NO. ! . ww' w.stoveshoppe.com www.fencesunlimited.com email:,info @ stoveshoppe.com wv The Commons•25 Indian Rock Road•Rte.111•Windham,NH 03087 : i • ; Certificate of Occupancy $ Building/Frame Permit Fee $ ' Foundation Permit Fee $ $z; Other Permit Fee"`_ $ k. TOTAL $ R �f a Check # t/0, r. 18724 --Building Inspector'/ P• TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER DATE ISSUED SIGNATURE: Building Cossioner/19SR22LDr oWWldings Date SECTION t-SITE INFO TION 1.1 Property Address: 1.2 'Assessors Map and Parcel Number: 94p- vobD- Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronts ge 0 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide ReqWred ProvidedR 'red Provided 1.7 Water Supply M.GL.C.40. 54) 1.3. Flood Zone Infornution: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes_ No_ 2.1 Owner of Record icy ne fn0 C0Yjr)V HIS ( ry a Name(Print) Address for Service: t Telephone 2.2 Owner of Record: Name Print Address for Service: z S1 store Telephone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Z Licensed Construction Supervisor: ; License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name '�lS 1J-13f3-1E/L (j&d Gyt~jD60,1,) L(q 0433 Registration Number �m Addressrow led) '\ - Q7 �� d o2 Expiration Date � �` Si na Q Telephone 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 wdl result in the denial of the issuance of the building permit. POT APPA CA6LC ' 50L6 X0PAI&T1-y?- Si ned affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Desc ' ion of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be _ OFFICIAL USE ONLY, Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)Y (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) \o ,21�0 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 au ed by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 r r P Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 ST 2ND 3 RD SPAN DIMENSIONS OF SILLS DEvMNSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BU1lDING CONNECTED TO NATURAL GAS LINE C ORT � Town 0 . t over No. y 1 A O dover, Mass., COCHICHEWICK A. �l,9 A°RAre® BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........... r........................................... ........................... Foundation A6 has permission to erect........................................ buildings on ....A/q$*W ........... ........ Rough tobe occupied as........... ........ . ....................................................................................................... chimney provided that the perso 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 EXPIRES IN 6 MONTHS UNLESS ►�®T T STARTS ^ � ELECTRICAL INSPECTOR V 1 V LESS CONSTRU i\V N JTI�L�T� Rough ........ ..... ... ..... Service . .. . .. . . ... .. ... . ........ ING INSPE T'OR Final Occupancy Permit Required to Ocmpy 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 JI Smoke Det. ACQRD CERTIFICATE OF LIABILITY INSURANCE CSR CO DATE(MM/DDIYYYY) GEORG-2 01/21/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Neill & Neill Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 662 Riverdale Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Springfield MA 01089 Phone: 413-732-4137 Fax:413-731-6629 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: EMC Insurance Companies INSURER B. Georgetown Chimney Sweeps Georqe & Laurie Rose INSURER C: 218 Andover Street INSURER D: Georgetown MA 01833 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR �D U POLICY NUMBER E EXPIRATION LIMITS LTR NSRC1 TYPE OF INSURANCE DATE MMIODfYY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 2D9-97-28 12/02/04 12/02/05 PREMISES(Ea occure ce) $ 100,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,0 00 ... GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 X POLICY PRO- LOC JECT AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ IOIH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION INSUR-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Insurance Purposes Only DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN . Individaul Certificates ISSu@d NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL on request IMPOSE NO OBLIGATION OR LIABI OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTA � David R. Jarry ACORD 25(2001/08) OACOR CORPORATION 1988 �� 170?)7/I)LO?tL(/P,p.GL/L ��'GU4JCG(AZll4G[.CO Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Board of Building Regulations and Standards Registration: 114559 One Ashburton Place Rm 1301 Expiration: 10/4/2007 Boston,Ma.02108 Type: DBA GEORGETOWN CHIMNEY SWEEP / George Rose 218 Andover St _- 1 A19_ Georgetown,MA 01833 Administrator Not valid withou signature I I I i � ,n 0 ;"` ��'�.c'va-�! �•�t'z�-�' ,a ��� �a 4 I CC d� W/3 � �� � W-7/3 PIONEER PELLET STOVE IONEER BAY PELLET INSERT Comes standard with black painted door and convection grill Comes standard with black painted door and convection grill y is i y l' I pp , a a , I — i s l , 1 I I y��il t I u til P 1 A n t a. z � �k' • � °m'� »�' Y y, r v , a - J. . r LOPI's Pioneer Bay pellet insert is the ideal way to turn your inefficient open fireplace into a beautifully The Pioneer pellet stove is possibly the most beautiful LOP[ stove every made. With its high efficiency and efficient home heating source. Compact and easy to install, the Pioneer Bay is a perfect fit in almost any high heat output the LOPI's Pioneer pellet stove truly brings the art of fire to life. It's compact size and p masonryor metal fireplace. A three-sided fire viewing window and optional 24 karat old plated or Pewter elegant form fits any room in your home. The Pioneer's powerful two-stage heat transfer system and 8 -. p g p g convection air tubes will heat up to 1,600 square feet with quiet efficiency and exceptional comfort. arched door make the Pioneer Bay a sensational addition to any fireplace setting. The Pioneer Bay's attractive brick pattern fireback highlights the splendor of the fire while maximizing heat The Pioneer's durable steel construction, beautifully detailed top and pedestal castings and aluminum brick transfer to the room. A remarkably quiet, yet powerful blower helps distribute heat evenly throughout your fireback are enhanced by the optional 24 karat gold plated or Pewter accents and a full bay view window. A r yr home. The easy-access hopper holds enough fuel for up to 30 hours of continuous warmth-,just fill it up, set state-of-the-art ignition system allows you to manually start the Pioneer at the touch of a button. What's more, _^ the feed rate, then push a single button to activate the auto ignitor. Advanced electronic circuitry allows you a single control regulates the feed rate. You can automate stove operations by adding an optional wall thermostat, to operate the Pioneer Bay in either manual or automatic mode, and a wall thermostat or remote control remote control thermostat or modulating remote control',just set it to the desired temperature, then relax and thermostat can be added for the ultimate in hands-free convenience. let your stove go to work. The Pioneer Bay's easy-access ashpan and ash dump makes clean up simple, and the door swings open when The entire top of the Pioneer opens for easy access to an enormous 55 pound hopper. That's enough pellet needed for occasional firebox access. It's no wonder more people look to LOPI for the ultimate in beauty, fuel for up to 50 hours of uninterrupted heating! And thanks to the Pioneer's huge pedestal ashpan, you'll style, and trouble-free home heating. spend less-time cleaning and more time enjoying the warmth your stove provides. i zo I'll, zz 118" ` a° Overall Heating Hopper Maximum Overall Heating Hopper Maximum 21 "Z=zx I!s• " Efficiency Capacity Capacity Burn Time BTU Range* Flue Size k Efficiency Capacity Capacity Burn Time* BTU Range* Flue Size T � I} 82% 800 to 1,600 Low-8,100 3" 82 800 to 1,600 55 Pounds 15-50 Hours 35 Pounds 10-30 Hours Low-8,100 Y Square Feet Pellet Vent resx LLL1 q High-28,000 * y, Square Fee[ Pelle[Vent z9 vz^ � High-28,000 f _ HEATING CAPACITY.May vary depending on the degree of home insulation,floor plan and the ambient[empen[ure zone of the area tom. HEATING CAPACI'iY.May vary depending on the degree of home insulation,Floor plan and the ambient temperature zone of the area �r in which you live. Contact your local building or fire officials about installation requirements in your area. �1. in which you live. Contac[your local building or fire officials about installation requirements in your area. O 'BURN TIME and BTU range will vary with brand and size of pellets. 1`� i 'BURN TIME and BTU range will vary with brand and size of pellets. 9lls^ 115!x^ 1 PIONEER PELLI-tvSTOVE & PIONEER BAY INSERT s Large Capacity Hopper Automatic Operation • Fueling your pellet wove or insert has never Operate your pellet stove automatically.Add a wall been easier.The entire top of the stove or insert thermostat or remote control thermostat for the ultimate lifts up to allow access to the hopper. When f in hands-free operation. You simply set the thermostat to full,your Pioneer pellet stove will provide you the desired temperature and the Pioneer will do the rest. with up to 50 hours(30 hours for insert)of uninterrupted heating. The large capacityof If you choose tooperate your pellet stove manually, • the freestanding stove also means you don't simply set the feed rate,push the start button to activate have to wait until the hopper is empty before _.: the unique auto ignitor. Within minutes your Pioneer refueling with a full bag of pellets. (The pellet pellet stove or insert is in full operation. insert has a 35 lb.hopper). i i l° Huge Ash Pan The Access Designed as part of the pedestal on the stove, lifer 1� Y � y+ The Pioneer elle[stove and insert are t the huge Pioneer ash pan makes for –"" Pioneer designed for easy maintenance. The i significantly greater time between ash removal. swing-out door allows quick access to — A simple pullout handle above the ash pan Pellet Stove the firebox for cleaning and occasional allows accumulated ashes to be removed from `' � c maintenance. �,yl the firebox without opening the door. The Insert is equipped with an easy pull out ash pan located beneath the door. Pioneer Bay Freestanding Clearances to Insert Clearances to F1�" lace Unprotected Cgmbuslible Walls Unprotected Combustibles Stove clearances measured from stove top. Connector clearances measured from nue pipe. Mantle: Clearances To Combustibles: Insert Through the Wall Installation Interior Vertical Vent Installation combustible or non-combustible A-Min.32" (10" from hopper lid) 2"Minimum B-Min.35" 3"Minimum 1 �.. 3"Minimum Tee (13" from hopper lid) C-Min. 34 1/8" ; • (6" from hopper lid) D-Min. 15 1/2" (6" from hopper lid) f 9"Minimum E-Min.34 1/8" 0 9"Minimum o t (6" From hopper lid) a'Minimum Floor Protection 6"Minimum rO © Fireplace Min. Dimensions: F- 19 5/8" Through the Wall Installation Interior Vertical Vent Installation G-30" (includes circuit board) H- 16 5/8" (includes 5"for vent) 2"Minimum 3"Minimum f - 2"Minimum 2" ,�.. 45'Elbow Minimum - Installation: •' Y ..: RL=1 Tee �^ I-The vent should be routed to the tr A, Fireplace prior to installing the * insert. See Owner's Manual for " s s, details on vent location. " 2"Minimum 'i� 2"Minimum The insert must protrude 9 1/2" � r onto the hearth or the panels = e� , Floor Protection to fit s a.• "- Panel Size: Minimum Hearth Pad Size:22 1/2"x 26 7/8"Deep. 811 x 1011 Panels See Installation Manual for specifications on Alcove installations. 28 7/8"H x 40 1/2"W SAFETY TESTING:Warnock Herscy to UL 1482/UIX S627/CSA 13366.2/ASTM E 1509-95 1011 x 1311 Panels This pellet fired appliance has been tested and listed for use in manufactured homes in •� 31 7/8"H x 44 1/2"W accordance with Oregon Administrative Rules 814-23-900 through 814-23-909. Your Authorized LOPI Dealer: THE STOVE SHOPPE The Commons - 25 Indian Rock Rd. Rte, 111 - Windham, NH 03087 Ph: 603-537-0555 Fax: 603-537-0557 www.stoveshoppe.com Visit our WEB site at:www.lopistoves.com ®Copyright 2004 Printed In U.S.A. Lopi reserves the right to alter or improve its products at any time without notification. _ #98800201 p. t r tDate.................................. Nor+rM TOWN OF NORTH ANDOVER PERMIT FOR WIRING V _ ,SSACMUSEt a.. < r certifies that ..... ..................... .�- -Cep, ................................ has�permission to perform ........................."�""� wiring in the building of................................::°'.J......................................... at.................. .... .;....... .............................. .` ',North Andover;Mass. Fee..................... Lic.Nb...... ..`�.... ............................ ....... ....... ......... ,,.... ELECTRICALINSPECTO Check 1V DE MR7B1D1I1'OF1° BEICSIFW Pamir No. Ba41V0FF=P 9VfiVMNRFXi(iZ411gi M7(W tZffi O"m y R Fm Chedmd MPUCA77ONFOR PER1tN7,140 PERFORMELECnui ORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSST`S ELECTRICAL com 527 cmit `:00 (PLEASE PRINT IN INK OR TYPE ALL TriPORMATION) p� Town of North Andover To the Inspector of wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant o Owner's Address Is this permit in conjunction with a building permit Yea® No a (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Arnpa�.V olts Overhead Underground No.of Meters New Service Amps Volts Overhead Underground No.of Mete= Number of Feeders and Ampacity Location and Nature of Proposed Electrical work nA Na of U&ft oethu Na of Hat Tubs Na of Trawft en Totd KVA Na of Ltahth�Fi:tum SwlrnadnB 1W. Above VOW Below Oenntsn KVA Na of Receptede Oudw Na of OUR Na of Emwpwy Uandns Betray Units Na of Switch Outim . v Na of Oa Banton Na of Rnyeu Na of Air Coad. Told FUtE ALARMS Na of Zama TOM No of Dlepo"k Na of Nat TOW TOW Kw Na of Debw=ted Puns Ton No.of Diehwuhm Space Ani Halos KW N&of S=ftg Dedne Na of Sdf C=whW mMmuft Na d Dryer HoeftDevGoee KW Do �I COMKdon � a No.of Www Hector Kw Na of No.of - �+ Shm Bdlmb No.Hydro Munp Tobe Na of Moran Totd HP OTHER. het�nemvasigc PlsrBtbbelecfirore�idMadisetsClarealLaae Ihareawamtlis CaNO Y� NO Ihs�esttbtriledvtidptadd imeCmma Yl� I)ouhriect�*I%lYMPka�irdeale1vtFdwmVbp d`reddr�fre ZMI AIKB B=C] t'7M [3 �ieasespec�yj WC&k) lim�et�iartlDsleRaysstid E�mdbdVairedPJetdc+lwcdt S urid,r� i�dpa�r � K C ( \ � �J LiMaNa S a tjUxnwNb ® � - am _ Bmsirr.TbLNa _ 23 awry'sn�.�Nr�wAtv>�;Iamawatenetinet;� `� AMNa �°1°�cw°�oridsi�'IY°�'�almtasau}iMbYMa®dsBees(3QraiiLa+M ardtlie¢rr�sip,raeanlHapmnitappic�enri�ksli,eft (Please check one) Owner C3 Agent aiignum of Ow Telephone No. pg� ,FU 3 ��� DI�UDII�VTOF1'UB[�SA1�'8/Y � ��� BQARDOFFWPRIs'VF1V1WRB�ILA7�Q1 M7C1WA0 tPemdttato.W7 dt Fes Checked APPUCATTONFOR PERAff TO PERFORMELEcnuC,AL WORK Au WORK TO BE PEMRM®IN ACCORDANCE WITH THE MAWACMSSTS ELEC17R1CAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL 2MRMATION) Town of Noah Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street d:Number) P` Owner or Tenant F✓ �" Owner's Address Is this permit in conjunction with a building pit: Yes M/ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service , Amps olta Overread Underground No.of Meter _ New Send= Amps Volta Ovedwo d Underpound Q No.of Meter Number of Feedern and Ampacity Location and Nature of Proposed Electrical Wort No.of Upaing Oudw W of Hot Tubi No of 7Yaoeattraen Total KVA Na of Uahthy R=M 9whamins Pod' Aboverj Beiow Oeoeretoat KVA Na of Reoepuob Oudw No.OfORAWMa Na of Emersonq Uahtins BNtery Units No.of Switch Outlets No.of Oee Burum Na of Rsnaa No.of Air Cond. Taal FIRE ALARMS Na of Zonas Tad of Dbpoasb Na of Hat Told TOW Na of Detection attd. Tow KW bido ft Dsvkw No.of Diehwaehxa SPwe Am Hkmft KW Na of Sounding Devices No,of Self Caatshtedd No.of Drym Hoeft Devioee KW { � No.of Water Heaton Kw Na Of Na of ❑ Connections slow Bdbob. Na Hydro Mmw Tube Na of bloom Told HP OTM. h mmlom mV PAUltio bess}irmr idM=d>tiWCiatml1m ItzwaoaWLjAftJni eeRtj'kckftCtrr aridst>bdWWegirdet yE IhmsrbrkdYaidpt�odd s>zC>moeY14 ZlouWmdredmdYKpk= * typed Wmb amllft B=p 013M p Estis�dVdzofEbmWwPodk s WOkbsat �� �a ad BeFbslbd \ �J Ek=Na Ste_ son" � � ✓1-�-�--� I�aarseNo min ambeigUNd, 3 W 013 Q O)e- (,&3)1.<—,.n S Q1 Al, PR61)O OWi�R'sII�6[IItM�[EwA1VPl Iamarterehot�heLicalte lheilanrx�e AlTdNa k3 362 ?�'J i . ardtlletrr�siBl�rzond�ispmrlksppic�tci�hsfiraq�imiet ��s��04�m��bYa�Ger>eilLswt (Please ebeck one) Owner p Agent a Telephone No, pgta m.FEE 1 216 Location BOCQJAPA1� ,., No. Date 19 kc 40RTN TOWN OF NORTH ANDOVER 'Certificate of Occupancy $ Building/Frame Permit Fee $ ssCMUs<� Foundation Permit Fee $ Other Permit Fee Sewer Connection Fee $ Water Connection Fee $ r, TOTAL + C. 1 Building Inspector 07! 12:40 15.00 PAID 540 Div. Public Works PERJIIT N0. APPLICATION FOR .PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP +40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. LOCATION 15 �nIC-t{- wL PURPOSE OF BUILDING OWNER'S NAME5MW � ` 1 � NO. OF STORIES C SIZE OWNER'S ADDRESS I / y'[�//1 yl BASEMENT OR SLAB ARCHITECT'S NAME G— SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME / py-�„�A �I O f.� ing— SPAN -- DISTANCE TO NEAREST BUILDING V� �' DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS O AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION , eyil IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ACJ IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY A J IS BUILDING CONNECTED TO TOWN SEWER j IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST lobU PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 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 FIL D A D APPROVED BY BUILDING INSPECTOR DATE FILED - SUILDING INSPECTOR 81GNATU ER AU O ED AGENT •#f` 1 A s F E'E OWNER TEL.# PERMIT GRANTED (� CONTR.TEL.# 19��_ T CONTR.LIC.# H.I.C.# i BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S ORIES TOT LINES HIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY __ OFFICES k LAND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/. 1/2 1/1 FIN. ATTIC AREA _ NO 8 M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 22 f 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I I HIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING , WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. 8 COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G I UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING gS} 4,i F ORT C_ TO" , oover INTO. ' 348 _ i t dover, Mass., y I 19 qS C% t ` o LAKE COC KICMEWICN V A°R TED BOARD OF HEALTH 1 H E Food/Kitchen PERM Septic System IT Ti BUILDING INSPECTOR THIS CERTIFIES THAT S' t;� W..................................................................................................................... ' p_ Foundation has permission to ereet-'��1u,c+C............. buildings on. a^..� �G !! .....�`! ............... . Rough r $ to be occupled'as. .Yr��'�:... ..! �4. ..... �i� ,...... . . ... ...V.� ............................. Chimney provided that the ersorl acce tin this permit shall In every respect conform to the to s of the application on file In Final his office, and to the provisions of the odes and By-Laws relating to the Inspection, Alteration and Construction of . Buildings;in,the Town of North Andover. PLUMBING INSPECTOR VIOLATION of theZoning or Building Regulations Voids this Permit. Rough Final 1 p A PERMIT EXPW6MON THS ELECTRICAL INSPECTOR JA UNLESS CONWT Rough i .................................................................... ......... Service { BUILDING IN CTOR � Final ➢`�' Occupancy Permit Required to Occupy Building GAS INSPECTOR a` '+ rDis la in a Conspicuous Place on the Premises — Do Not Remove Rough a P Y P Final No Lathing or Dry Wall To Be Done I , � Inspector. FIRE DEPARTMENT., Until, and Approved b the Building Burner ` Street No. PLANNING FINAL CONSERVATION FINAL } { Smoke Det. x ',, SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT TOWN of NORTH ANDOVER AFFIDAVIT -H.me hurmvmant Cxmmtcr Taw anlanffi to Pamtt P pliratim Ml<.c. 142 A ragires that the "imor irtiai, altsadnn, rmmM im, repEdr, wh:nUaticn, conrsim, igXMWait, remml, damlitiai, or ca mtii dm of an adiitim to ay per- a astirg awEr-o=iled b id- irg amtAnirg at lust one hit riot Mxe that far did1liig unts...or to stnrbxes Oddi are adjacait to ar-h 1 sidE=e or hO dW'be&m by rpg7s d o<IM=taS, xnth catain acTticus, alLlg idth odxs7 r D waits. k Type of Work: �� � C Est. Cos t Address of Work fWfC� Owner Name: UFS lJ Z Date of Permit Application: 7(/(2 I hereby certify that: Registration is not required for the following reason(s): For of Eire Lbe Qily Work excluded by law Pardt Ni). Job urider $1,000 Date PAilding not owner-occupied Owner pulling own permit Other (specify) I i Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONIRACIORS-.- FOR APPLICABLE HOME 14PROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. S4PEd uxkr pemalties of perjtxy: I hereby apply for permit as the agent of the owner: Date Contractor Name Registration No. .OR Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name I ?11 _ t _s. _.....•. ... r - �r - l ---------- __-w--____.mow __ ---_._._____._. - ---•- .�� -- _: -. i��. a g 1 � � � � � � S � f s �' f ' .— �— Z { Lei � ; _._., ,,.,_ � _ is i � —� -- — '—--— I Location ���i.�,-�.►.� , �i� No. l f (/ Date //1-l- SORT►, TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ ,SSAGMUSEt� Foundation Permit Fee $ OthePermL�r e $ /y, �ECEIVED JConnection Fee $ OCT � F1�'Water gAnection Fee $ � J I -'1' AL $ °�(A'7'd®ller oaf //AI f � Building Inspector Div. Public Works :Ryt`�Q: � APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. V PAGE i f _ 1 EMAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. I I 1 LOCATION PURPOSE OF BUILDING OWNER'S NAME IL- Tso NO. OF STORIES SIZE OWNER'S ADDRESS S VC_. /J/ _ --�, BASEMENT OR SLAB ARCHITECT'S NAME �.�. �v SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS l DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS if AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW L9 SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION JYT^ O •/f,� i/}� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE ,I INSTRUCTIONS 3 PROPERTY INFORMATION LA D COST SEE BOTH SIDES EBT. BLDG. COST ���U (.j 0 PAGE i FILL OUT SECTIONS 1 - 3 EBT. BLDG. COST PE SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 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 ILED f BOARD OF HEALTH 8iGiiATURE OF OWNER OR AUTHORIZED AGENT FEE r To OWNER TEL.# --5M-b7Z-7/Z? PLANNING BOARD PERMIT GRANTED CONTR.TEL. 2pr� 19 CONTR.LIC.# BOARD OF SELECTMEN OCT -- 1 1992 �� O ■uILDING INSPECTOR BUILDING RECORD i 1 OCCUPANCY 12 INGLE FAMILYSPORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM ULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- PARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. i CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH ONCRETE _ d 1 2 I3 I ONCRETE BL'K. PINE RICK OR STONE HARDW D IERS PLASTER _ DRY WALL _ -UN FIN. 3 BASEMENT REA FULL FIN. B M AREA _ '/t % FIN. ATTIC AREA _ 0 B M FIRE PLACES _ EAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS LAPBOARDS B 1 2 3 ROP SIDING CONCRETE �_ FOOD SHINGLES EARTH SPHALT SIDING HARDW*D SBESTOS SIDING _ COMRACN _ ERT. SIDING ASPH. TILE _ rUCCO ON MASONRY _ IUCCO ON FRAME RICK N MASONRY ATTIC STRS. & FIOOR _ RICK ON FRAME + ONC. OR CINDER BLK. , f` TONE ON MASONRY WIRING SUPERIOR DEOUAATE 1_ 1 POOR TONE ON FRAME _ AONE 5 ROOF 10 PLUMBING ABLE I BATH )3 FIX.) AMBREl MANSARD TOILET RM. (2 FIX.) .AT SHED WATER CLOSET _ i SPHALT SHINGLES LAVATORY _ 'OOD SHINGES KITCHEN SINK _ LATE NO PLUMBING _ 4R 8 GRAVEL STALL SHOWER _ OLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 8 FRAMING 11 HEATING 'OOD JOIST PIPELESS FURNACE " FORCED HOT AIR FURN. _ IMBER BMS. &COLS. STEAM rEEL BMS. &COLS. _ HOT W'T'R OR VAPOR FOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GOAL M'T 2nd _ I ELECTRIC y1 13rd I NO HEATING y I �������r r � ► dm � . ..�.-..� � .. ,�; ,� :r �����Anaover .VVE /WATERATER FINAL own of � fir.+ 6n/O�o No. 46A . ' T "Now ®R C E , a er, Mass...,_� 199' h AORF P�� BOARD OF HEALTH ' PERMIT T LD THIS CERTIFIES THAT.. 0.f .. ......................................... BUILDING INSPECTOR has permission torr.l� l. . ..11r..., ,�.ts ..�.. .•............• Rough y�i/....ASA*.&R•,rl .choN Ir. Chimney tobe occupied as...... .. .... ............................ Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTIO START , Service Final BUILDING INSPECTOR GAS INSPECTOR i Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner o Lathing to Be Done Until Inspected and Approved by Smoke Det. �S�G o Building Inspector k- Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only NAME OF CITY/TOWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction,alteration,renovation,repair,modernization,conversion,inprovement,removal,demolition, or construction of an addition to.anv pre-existing owner-occupied building containing at least one but not more than fourdwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors,with,g!�5ain exceptions,along with other requirements. ,y� �fair 0 Type of Work: // VP_) Est. Cost ,—/0 Address of Work Owner Name: Date of Permit Application: ® ' I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under $1,000 Building not owner-occupied Owner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: , Date Contra r Name R stration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name , n ja I S CONT)t4C ,tt 4 to Pbonie: (508) 373-8909 10 �i No job too small ;b v`''• GENERAL C01 FROM START TO FINISH a''f;`: !^3 4 •New Consto an *Pre-Fab Home set ups •Deeks R Garages -Remolding •Additions {� 267 School St. ;`M, { j}_ Lie_R Ins. P.O.Box S Bob Sherburne Groveland,MA 01834 y �yiY, DATEd 19 t `< k ' TO i l,� :'•tj�t Y0.SY��xti - 'eS� tdi Awa z x" t'y5, Mt PHONEi,, i JOB DESCRIPTION 4 .01 - k ytiii I V per. • ' � �; � x � t 0C (1�o..' T. �s tx�u �a {tait s;.4 ` { 4' { , �t ('S All quotes given are good for 30 days. Prices are SUBTOTAL subject to change if material costs fluctuate. Any site preparation work or additional material it in DEPOSIT addition to quoted prices unless otherwise specif- ied. All ,jobs are COD upon completion and total balance TOTAL COD BALANCE DUE is due upon completion unless otherwise prearranged. Page No. of / Pages RICK SWEENEY Renovations, Additions & Decks P.O. Box 149 YORK HARBOR, MAINE 03911 (207) 363-7567 PROPOSAL SUBMITTED TO PHONE DATE Gail Mancuso 508-682-7122 9/29/92 STREET JOB NAME 45 Buckingham Bath renovation CITY, STATE AND ZIP CODE JOB LOCATION North Andover, Massachusetts Same ARCHITECT DATE OF PLANS JOB PHONE Work 508-373-1666 We hereby submit specifications and estimates for: d�� Qi fi&70A tuiLl- $7fi1V"��� Tile material allowance $ 127 . 00 Gut existing bathroom down to wall studs and sub-floor. Leave . .... .. .:...... . . ............................................................... ...... ........... .......... ..... . ......... ......... ........ existing ceiling material in place. Prepare tub area for plumber ' s installation of new cast iron tub. After tub, rough plumbing, ..................................................................................._......................................................................................................................................................................................................................................................................................................................... ._....._................. and rough electrical( ALL BY OTHERS ) has been inspected by town, .................................................... ....................................._................................._............._......................................................................_......................................._...................................................._................................... ....... ......._......_....._......._.............. insulate walls and install Dura-rock tile board. in tub area, and moisture resistant wall board on remaining bathroom walls. Tile tub area ONLY from tub to ceiling ( approx. 75 sq. ft. ) . Finish MR board ready to accept wallpaper. Sizing and wallpapering BY OTHERS. Install crown-type moulding at ceiling, install OWNER SUPPLIED lav cabinet, surface mount ;medicine cabinet, and towel and paper holders . Supply and install oak base where necessary. Supply and ......... ............... install new 3h" brass hinges and new colonial casing on door. All painting and/or staining BY OTHERS. Remove debris from site. P VrapnsP hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: One Thousand Three Hundred Eighty-Five dollars ($ 1385 .00 Payment to be made as follows: $ 400 deposit at contract (start date 9/30/92 ) . $ 500 the and sheetrock completed., Balance ( $ 485 ) due up n omp -fit ' All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifica- Authorized tions involving extra costs will be executed only upon written orders, and will become an Signature I s extra charge over and above the estimate.All agreements contingent upon strikes,accidents ' or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Araptattre of Frapasal—The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: �( �'/ 9/C�� Signature PROMCT!18-3 L E'e Ioc.Groton-Mass.01471 To Oder PHONE TOLE FREE 1+800225-6380 P �� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Oate ..196 Permit Building Location Owner's Name G�i (,fT/✓ Type of Occupancy__ New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ N N ¢ • W N N N t) N ¢ N R O N Z F- W N = Z < 07 N F- g4j W O C d C d ¢ N C7 W 4 = _ �.. vs C7 > 4 WZ v W W < ¢ Z• In ILA F' S W ' J Z ¢ Q :s! W y ¢ W O > U- F'• J _W < W >: -¢ W Z Z. < ¢ < < O O W O ¢ Z O v IL 7 O r7 J tj ¢ > C 6 Y' O SUB—aSMT. BASEMENT 1ST FLOOR 3RD FLOOR D 4TH FLOOR STH FLOOR 6TH FLOOR I 7TH FLOOR STH FLOOR Installing Company Name Check one: Certificate Address vim/ LAY Carporatlon ❑ Partnership Business Tefephone,,.r0S,' to ❑ Firm/Co. i Name of Licensed Plumber or Gas Fitter C INSURANCE COVERAGE: 1 have a current jJaWlIty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes C- No ❑ Ii you have checked yes, please indicate the type coverage by checking the appropriate box A liability insurance policy Ejl� 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 Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: 5+gnature of Owner of Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)In a ve applicat on are true a a rate o th est of my knowledge and that all plumbing work and Installations performed under the permit! ed for thl pplication b n PH with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the eral taw Typja of Ucense: Title H P'llumber ignat e of Licensedum er or Gas titer fillet �� � City/Town aster Ucense Number APrn0VF Journeyman O . e Date. 2125 e.3 F HOR,., , TOWN OF NORTH ANDOVER ,A ti cc 0 �0j. op PERMIT FOR GAS INSTALLATION. « .'. �9SSAC'HULO SEtt This certifies that . .eAl 44 h A , _ , . . , ^ has permission for gas installation in the buildings of tom.R. '. . at .,r 4 r_./f. y.��?.. , . . . . , ; , North Andover, Mass. Fee.S B... . . . Lic. No.J.yX0. . . . . . . . .. . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer . GOLD:File Date. ,40RTN TOWN OF NORTH ANDOVER of PERMIT FOR PLUMBING SACHU /6/.. . . . . . . . . . This certifies that . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . buildings o //1 1 .. plumbing in thp,buildf, ........ . . . . . . . . . . . . . . . at North Andover, Mass. . . . . . . . . . . . . . . . Z-. . . . . . . . . . . . . . . . . . . . . . . . Fee. . . . ... . . .Lic. No.. . . . PIUNI81 INSPECTOR Check # 5663 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS —7 //_ -p r �+ /�� ,�" L Date /10 Building Location t� Cil lT/LI Owners Name /`®� Permit# ,S l oG3 rS Amount a�'O° Pol Type of Occupancy /`�� New Renovation ® Replacement ® Plans Submitted Yes No FIXTURES rZ � Q ` r StBEM 1 M RfM ZD FIDQt �FIpCIt 4IH IlaR _ 5IH H-OCIR f' 6M HDM 7IfI I+IDQZ SIH R R2 (Print,or type) r— _` -J ��^—,(� Check o Certificate Installing Company Name Address a ® Partner. Business Telephone J'i3 ® Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box: '� Liability insurance policy Other type of indemnity D Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have ubmitted(or entered)in above application are true and accurate to the i best of my knowledge and that all plumbing work and in Il 'ons der Permit Issued for this application will be in compliance with all pertinent provisions of the Massac S t Jode and Chapter 142 of the General Laws. By: �gna o r Type of Plim6ing License Title City/Town License Number MasterJoumeyman APPROVED(OFFICE USE ONLY Date.�f1'.`r�`7".°.`.. . . . . . Of NORTH 1ti O? TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION .i SACHUSEt This certifies that . . . .�.�� :�. . S'f� �" . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . in the buildings of . . . f. . . . ' at . . .t.) . . . �.ti.----. . . . . . . , North Andover, Mass. Fee. . . --. . Lic. No.. 4 . GAS INSPECTOR Check# P C' 4981 i MASSACHUSETTS UNIFORM APPLIC. TON FOR PER1VllT TO DO GAS FTrrING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations �l��( � y' v^ Permit# � Amount$ Owner's Name New❑ Renovation ❑ Replacement �` Plans Submitted ❑ U pUF v� 5' a c °o E°+ ►+ w � � `J z w . 0 tr, A C�7 a °U a 0 a F 0 SUB -BA EM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 8 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) C ec one: Certificate Installing Company Name � f ff Corp. Address 13 0 Fd ❑ Partner. BusinessTele one of ? Z- /„ �/ ���� []-Firm/Co. ��----a--�--L � Name of Licensed Plumber or Gas Fitter �� Lj �¢��G�• Ls� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No If you have checked Les,please indicate the type coverage by checking the appropriate te b ❑ 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 Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent. ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed un er Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse State w Code a Chapter 2 of the G�,neral Laws. Signature of Licensed Plumber Or Gas Fitter By: Plumber V ,3 Title City/Town ❑ Gas Fitter License Number Faster APPROVED(OFFICE USE ONLY) ❑ Journeyman i w Date. f . . � �T •S u „ORTM TOWN OF NORTH ANDOVER Q� ,�•o ,•,tiQ PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . . . . . . . . . . . . .... . . . . . . . . . , has permission to perform .4 . . . . ... r1. . . . . . . . . . . . . . . . . l plumbing in the buildings of . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at ' . . _. . . . . . . . . . ... . . North Andover, Mass. Fee,,:�!4. . .Lic. No.. . . . . . . . . .z. . . . . . . . . . . . . . . . . . . . . PLUMBING.INSPECTOR z Check # 6264 MASSACHUSETTS UNIFO APPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER,MASS A CHUSETTS L g (�t/eK�w / Date r O Building Location k !� Ow ers Name 101� ✓_e r(60r e Permit# 36 Amount Te of Occu anc f✓° `�-� 't' Vdr New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES 0 09 C4 v ri v 19JU E Brig Wff d 1ST IHIDCR ZD DDM fid. RDM 41H HJ" 5MIMM MM r, 6MHf= } 7MHOM (Print or type) �f / Check one: Certificate Installing Company Name (1` V ,�L /��c�r�e }�.+f ❑ Corp. Address 3) JC FD Partner. Business Te ep one �, ,�" _, /� R^ 13—Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type.of insurance coverage by checking theappropriate box: Liability insurance policy Other type of indemnity ❑ Bond i� Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above pplicatio are true and accurate to the best of my knowledge and that all plumbing woLMassZach d installa' perfo un r Pe ' ssued his application will be in compliance with all pertinent provisions of the tt ate Plu o e and ap.ter of the Gener S. By: Signa re-ni I-RAMSeLl rium er Type of Plumbing License Title City/Town icense NumBer MasterJourneyman APPROVED(OSCE USE ONLY � ❑ E TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ORTA.NT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes 'n Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building X6ne family ❑Addition ❑Two or more family ❑ Industrial •,Alteration No. of units: ❑ Commercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other [7 S eptic ❑Well r 1`a'0 Flop dplain4`° 'D Wetlands £#❑ Watershed+District' t W'"`.—.-. -ap, f mit.. t a,.f er t-._ _ a l c1,LpR �S#d.,A. C4`"t••y ;. K 4 ,+ '� ,� 46 �,�; . _0_Water/Sewer' DESCRIPTIO OF WORK TO BE PERFORMED: .k. t" LX. W Ile y Identification Please Type or Print Clearly) OWNER: Name: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: 12— I-C� �- Home Improvement Licensees Exp. Date: TIENGINEER''t t. Phone: /( Address: b Wy/� :.., Reg. No. �3 FEE SCHEDULE:BULDING PERMIT:$92.00 PFR$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: 12 Receipt No.: 0 NOTE: Persons contractin,with unregistered contractors do not have access to the guaranty fund t_S - i eo natur er;- f ntracfoj Signature.of;-�Ag_en ��• - - --- -s—=----------= - - - Location , 1 '° Date f No. ' I I MOIITN TOWN OF NORTH ANDOVER ..Sol . • certificate of Occupancy $ �,'••••••'�� Building/Frame Permit Fee $ Ss�cNuSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # — i 24 i 06 Building Inspector I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ [Pub OF SEWERAGE DISPOSAL c Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ e(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 Signature COMMENTS 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 FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMIVMNTS 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 NOTES and DATA— For department use i ® Notified for pickup - Date i Doc:.Suilding Permit Revised 2008 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 Decks ❑ 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) o Building Permit Application ❑ Certified Proposed Plot Pian ❑ 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals A the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording ist be submitted with the building application Doc: Doc.Building Permit Revised 2008mi ORTH ® oo _ 6 over o dower, Mass., 0 LAK I� COCHICHEWICK ADRATED PP�,`�C� S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �.. ........ .. ........... .... ... ................................................................ Foundation 0 has permission to erect........................................ buildings on .........y �y`..ki1. � �1► • Rough to be occupied as...��.... ...................... 1!! ....... ..............�w./.. ........ . / 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 EXPIRES IN 6 MQNTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N T TS 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. TEL: (603)382-6166 9 WENMARK ROAD r _ ` NEWTON, NH 03858 Vka C61!4" (6�, t-Ae- MaY 5, 2011 North Andover Building Department 1600 Osgood Street North Andover, MA. 01845 RE: 45 Buckingham Road,No. Andover. Dear Building Inspector, Please be advised that I have Completed the Inspections on the construction of the Microllam-Steel make u beam and the beam supports, and I certify that the construction meets P pp fY my design intent and the Massachusetts State Building Code. If you require an additional information lease contact me at office. Y q Y P Y Sincerely, Ronald J. Pica,P. E. R. J. PICA ENGINEERING CO., INC. p� Ronald Pica C3 Structural rn—' ,o �fb 31369 90 � L Q Gt P ,c STS ONAL s j 20 l/ CIVIL&STRUCTURAL DESIGN • STRUCTURAL INVESTIGATION •TRAFFIC IMPACT STUDIES CONSTRUCTION MANAGEMENT 9 EXPERT TESTIMONY _ # Specifications 1. All work is to conform to the latest addition of the Massachusetts State Building Code. 2. Contractor must follow product'manufacturers recommendation and procedures during installation. 3. Steel plates must be A36 and steel bolts must be A307. 4. Contractor must be responsible for any and all necessary shoring and must maintain safety for private property, workers, and occupants. 5. The support for the new beam located near the existing, first to second floor, stair must be field designed once the finishers are removed. The design will include evaluation of the first floor framing and footing. 6. All changes in the design must be approved by the engineer. 7. The design is considered to be design bad since changes may be required once the framing is exposed. 8. R. J. PICA ENGINEERING CO., INC. Scope of work and responsibility is limited to the design of the support of the second floor beam and the beam supporting elements. 9. All work must be certified by the structural engineer. 10. The contractor must coordinate his work with the engineer for inspections, field design,and design changes. 11. If changes are made during construction the contractor'must notify the record structural engineer for approval. H OFtij�'pal o� itald J. �y z Pica rn v Structural 31369 G/STEP �SS10NAL s_- Stractural 45 Buctn gham Road f R.J. PICA ENGINEERING CO.,INC. DATE �7/4_// Beam Detail North dover MA. 18 Wenmark Road.,Newton N.11.,03858,603-382-6166 E'X / 5 1A G 0 m"I'tvG 7n 'PE 'AJ14?/LE"D -7® 7-AE N)-cF'av art 17 p o `I7 —0 IV.G =5/f� P!�°iES 0 O I C E.til"T�Yt�ED �v Ce5' ?/I ZOO 67r/ O j p O — 20, o y cPf Sr DF- Qtr = tet F-.p fir$ c 3 P <cps 19x 7"y? t ��PLZH OP F�,�ss Ronald J. Pica v rn n Structural J 31369 C'tSTV-@` ass/ONAL :31. 21 tructural 45 Buckingham Road R J.FICA ENGINEERING CO.,INC. DATE 4 eam Detail Nortb Andover MA. �8 Wf-nmark Road Ne _ Newton,N.H.03858 G03 382-G1GG f . r i The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02I11 www.massgov1dhz Workers' Compensation Insurance Affidavit: Builders/Contractors/lvl,-Ictricians/Plumbers Applicant Information _Please Print Legibly Name(Business/Organization/Individual): �jh'rL{( k4wil ,,, Address:_ l5 C� j�✓��jc. City/State/Zip: It$ln /�U JOVW 40V 00i Phone#: IS ` "' T*P,72 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. ❑I Zew construction employees(fii l and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7I:emodeling ship and have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers'comp.insurance. 9. ElIMIding addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions Yquired.] officers have exercised their 3. am a homeowner doing all work right of exemption per MGL 11.❑T lumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.[(I.00f repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑'Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy inform;rtion. 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 their worke rs'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below;s the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip- Attach ity/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 i 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 maybe forwai ded to the Office of Investigations of the DIA.for insurance coverage verification. I"do hereby cunifer the pains andpenalties ofperjury that the information provided`above asrytrue and correct. Si ature: I Date: Phone#: - a s [[Offuse only. Do not write in this area,to be completed by city or town official ity or Town: Permit/License 0 fIcial suing Authority(circle one): i Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing baspector 6.Other Contact Persoh: Phone#: paerM T oFRtLP, ,b.ti OWN OF NORTH ANDOVEIR: 02 at;r _` �°) OFFICE OF BUILDING DEPARTMENI, 1600 Osgood Street Building 20, Suite 2-36 ��m°° CFIlSS� ^•Ck s North Andover,Massachusetts 01845 54 Gerald A.Brown _ Telephone(978) 688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTIO14 BUIDING PERMIT APPLICATION Please print DATE: 4 ry, JOB LOCATION: 4 %1jvcle-.i 44y Number Street Address Map/Lot IiOMEOWNER �� - Gtr-( qq71v3 Name ome Phone Work Phone PRESENT MAILING ADDRESS 6)�*X 001!'77+ AIvevA4— 01644' City Town --Tip Code The current exemption for"homeowners"was extended to include owner-occupied dwc;]I.ngs to two units-or less and to allow such homeowners to engage an individual-for hire who does not possess a licerist.,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on whici there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andovcr Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. _ . HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Specifications 1. All work is to conform to the latest addition of the Massachusetts State Building Code. 2. Contractor must follow product`manufacturers recommendation and procedures during installation. 3. Steel plates must be A36 and steel bolts must be A307. 4. Contractor must be responsible for any and all necessary shoring and must maintain safety for private property, workers, and occupants. 5. The support for the new beam located near the existing, first to second floor, stair must be field designed once the finishers are removed. The design will include evaluation of the first floor framing and footing. 6. All changes in the design must be approved by the engineer. 7. The design is considered to be design-build since changes may be required once the framing is exposed. 8. R. J. PICA ENGINEERING CO., INC. Scope of work and responsibility is limited to the design of the support of the second floor beam and the beam supporting elements. 9. All work must be certified by the structural engineer. F 10. The contractor must coordinate his work with the engineer for inspections, field design,and design changes. 11. If changes are made during construction the contractor must notify the record structural engineer for approval. j! OF S �? Ronald J. 9Cy X Pica N rn o Structural p 31369 CJ G/STEL Fss/ONAL tiN� Structural 45 S1 Buckingham Road R. PICA ENGINEERIN G CO.,INC. DATE Beam Detail North Andover MA. 18 Wenmark.Road.,Newton N.II.03858,603-382-6166 /-5 7/1V G 2 Fri✓ri�vC 70 Sg- Al HiZFD -r.0 7-A,C- x vL '-s O p 2-%7 'L.OIi%G .5� E`F L O x N O � i O O 'G 20. o Sf D� - ��� o� Ronald I goy rr Pica u v Structural :i jII; 31369 �� a ` G P / 0 G ,c ESTE � NAL Structural 45 Buckingham Road R.I FICA ENGINEERING CO.,INC. DATE Beam Detail North Andover MA. 18 Wenmark Road e03858,603-382-6166¢ N wton N.H. W I I A '- .__ i I Patrick Gaffny 15 Colgate Drive North Andover, MA. 01845 April 29, 2011 Town of North Andover Building Department Please be advised that I am requesting a Building Permit for a home I just purchased at 45 Buckingham Road. Due to the condition of the kitchen I am unable to move in immediately. If my application for a Permit is approved I assure you that my Fiance and I plan to move in as soon as possible and plan to make this our home for years to come. Thank you Patrick Gaffey