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Miscellaneous - 45 CHESTNUT STREET 4/30/2018
/ 45 CHESTNUT STREET 210/059.0-0093-0000.0 E t 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 wiringshall be uniform throughout the Commonwealth and applications shall be filed � PP on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time ofongoing construction activity,and may be-deemed-by the-Inspector-of__Wires abandoned-and-invalidifime . ._ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. dq Rule S—Permit/Date Closed: ***Dote:Reapply for new perm 0 Permit Extension Act—Permit/Date Closed: \ Date....... ......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... 4,7. ......... has permission to perform ......... A.r-z:A.,t. .................................... wiring in the building of............/1,kj9AZ-1............................................... at.. .. ...................................,North Andover,Mass. ASO gn Lic.No Fee........... ...... No. .....h ]ELECTRICAL INS7 ir Check # 0619 1 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] Ieaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOl9 Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 9 6 C©U 21 Owner or Tenant paM —k-)x eA ik V--) Telephone No. Owner's Address 3 Pfn2. Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Buildingi l� 1.1`C 1/'�. Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity ° Location and Nature of Proposed Electrical Work: Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires ZC� No.of Ceil:Susp.(Paddle)Fans No.of Tota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El 'No' of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets , No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners No. InDetection and .S Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat PumpNumber. Tons..........KW____.._... No.of Self-Contained Totals:1 Detection/Alerting Devices . , No.of Dishwashers Space/Area Heating KW Local El Municipal F] Other Connection Heating Appliances Security Systems:* No.of Dryers g pp ' No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Dvices or Equivalent 3 No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: i Qt 000, (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: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: A•i " �; C'tl2l &IL LIC.NO.: (J33311A Licensee:C,oAL 1Vl-ISQDAJ 5R Signature LIC.NO.:3a335if (Ifapplicable,enter "exempt"in the license number line.) Bus.Tel.No..- 6-23 -IZ31 Address: )7(_: �Y 39-LM/0- <2)(70G Alt.Tel.No.:IF-1 -4�Cti 3` i *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. The Comionwom ofManwhaseft Departmutt of Indaserhd Accidents Offwe of Inpmfgadons 6011 Washington Shed Boston,MA 02111 www.Mass goa/aa Workers' Compensation Insurance Affidavit:Builders/ContractorsMecbidaus/Plumbers Aonlicaut Ln£armatio PICBM PAUt Name At S —Q�suy� �1 Pr,-W C ,S,nc. Address: 1 7 1 'S+cee+ CitylStatelZip: AAA DL20(, Phone Are you an employer?Check the appmprihte bole Type of project(required): 1. I am a employer with 3__,__ 4. ❑I am a general contractor and I 6. ❑Mw construction employees(full arxl/or part-time)-* have hired the sub-oonttacbors 2.❑ I emu a sole proprietor or partner- listed on the attached duet. 7• ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition [No workers'comp.insurance cow' '1 . ❑ � l 5We are a corporation and its 10.®:Ehxxrital repairs or additions 3.❑ I am r homeowner doing all work o have exercised their 11.0 Plumbing repairs or additions o workers' right of exemption per MGL 12.❑Roof repairs myself � t comp. a 152,§1(4),and we have no 1°s"m '�° ') a ployees.[No workers' 13.[]Other comp.insurance required.] 'Aay appMxnt that d oft Lax#1 mut also fin amt the a cfm below&*win&*wed= meww"m ply ic�ametioa t Homeownaa who aubmtt g&sffi&v#bAiWftfty=duiMaHwa&and thea bhe outside o00ftw0 ra now saixoit a>ww 4ffi&vit i N&ztnog such. i *M cbo*this box mud aft"W sn additiend sheet sheaW"the name of the sub-mftft�and state whadw or not those antis bane empbyeea if the nub-wntaw0ors have employees,&w nwa ProA&dw wa eW comp.poft numba. Jaw anea toyer drat is pnovlatiiig ttttn+kers'oda n iwssnnotw fer myecngal wee s. Blow is drepoliey and job side Insurance Company Nam.• Cy\bt c-�i S — Policy#or Self-ins.Lic.#: ( C.C'j®"i c-1°� 2.1 Expiration Dater 3 1 s Job Site Address: 'J!S C�AZ.-JZ fOU-r, City/Stato7ip: Q, A fy Y3 c5 V 21Z t-A# Attach a copy of the workers'eompeoadion polis►dedarstlen page(sbowtog the polley number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or owyear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a free of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Wawa-Agro Rion M for inswrM MMU n adi �a I ate hereby mo ander IkePdIM and pena Ww of pajwy dwt die&fiM notion provided above is tiers and wffect Sim= DI&W _ 2 — on= ��1- x,33- +as"7 offi au o not iiv ro Wer awn q cid City or Town: Permit/I3oeme# haft Authority(drde ones 1.80ttrd of fledth 2. Department 3.CWfrown Clark 4.EWdrW Inspector 5.Plumbing Inspector 6.Other Conal Person: now M. O I O NOV 13 1 0 - G �S 1145PEBY 4rdA7/Fy TO Tye T/T(E/WS6.MC, V, PG O T 7U T.S'E B,4N,f T.S�gT T.i�EOwEGG/.cit/S GUC'ATEO O.v T//E L0r f0-5;4V,rV ANO T/d4T/T"00CS coAl caehf /N ra—' OF.vo,.o v ao a ZON/NG c�E61/LATit�ivS i I FU.rrif�E.0 CE.�T/FY T//.IT T•fUS OM'ELL/N6 /S NCT LOG4TE0 /� T.YE FEOE.P.oG FiCOl00 f/•9Z•4.00 A.PE.4. �iP�i`✓/v FOiP SyawN OJV FEMA'CO•atMt/N/Ty P.ftICL '� � zS"Do9� 4Gb6 C �,4✓.L7 /�E�E'/Y7�G s rE/,� bo�-Ev 6`z`93 . F HOFMANN � 'O #36381 -v y i, �'�Fss+o�P /ffE.P.P/�fl.4G�E'.vGiciEE,Piti6 SE.Pvi�'ES ��Mo roe 66 �q.P� ST.rEET SURV£ cr''0 A�t/00l�E.0 A S °tS'`-T 1 9298 Date. . NORTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 '2$A US This certifies that .U. . . . . . . .rs . . . . . . has permission to perform . . . . .411" . . . . . . . . . . . . . . . plumbing in the buildin sof . . . . . . . . . . . . . . .��.�-'Q.!�. . . . . . . at . . .7�.. . .C4— CI. . . . . er. . . . . . . . . , North Andover, Mass. Fee. ��.Lic. No..-q4 � 7. . . .... . . . . . . PLUMBING INSPECTOR Check # �/ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CIT Af or 414 A N ckdve-r• MA DATE r-r—G /, &t Z[PERMIT tt JOBSITEADDRESS'q S C�es v:J/ C ( OWNEITS NAME) 0,44? OWNER ADDRESS 1�( TELT 97*-936--z('q 3 JFAX is- I TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ) RESIDENTIAL _ PRINT CLEARLY NEW..: RENOVATION:(REPLACEMENT: PLANS SUBMITTED: YES 1 .l NOJ J FIXTURES-1 FLOOR— BSM 1 2 3 4 5 6 7 a 9 10 11 12 13 14 BATHTUB -- CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM S I ( S DEDICATED GREASE SYSTEM ( ' DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I _ DISHWASHER DRINKING FOUNTAIN i ).............._' — I --- FOOD DISPOSER ( I I L ( J . FLOOR/AREA DRAIN INTERCEPTOR INTERIOR r KITCHEN SINK I LAVATORY ROOF DRAIN SHOWER STALL ---_. SERVICElMOP SINK TOILET URINAL If WASHING MACHINE CONNECTION � -- — - WATER HEATER ALL TYPES. -- _ - -- _ - - -- WATER PIPING - OTHER if } { INSURANCE COVERAGE: I have a current liab- ility insitrance policy.or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO i IF YOU CHECKED YES,PLEASE INDICATE THJeTYPE OF COVERAGE.BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY w I OTHER TYPE OF INDEMNITY BOND(_ I OWNER'S INSURANCE:WAIVER:I ant aware that the licensee sloes not have ihe'insurance coverage required by Chapter'142 of the Massachusetts General Laws,and that Illy signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of[tie details and information 1 have submilled or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations perfomhed under the permit issued for this application will be in compliance vAlh all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME IMa v-tc:. LICENSE it J/3.S.S-5 SIGNATURE MP1"-f'jPI �J CORPORATION) V 3,7Z6, 1PARTNERSHIP1 j#1 ILLC[ Ntl COMPANY NAME 11y Ac,'v//--f I ADDRESS 13/ A,,,A CITY�t/l1��tc� �� STATEIIiy/`/} ZIP 10 j9Y�7 - TEL /- 571E �3l✓ Z/q I FAX / , CELLI EMAIL 193 t i I I ROUGH PLY7NIEINO INSPECTION NOTES BELOW rOR©� � CE USR ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATIOMSMM AS THE PERMIT M. ❑ /� e1,� - FEE::$ PERNIFT 9 PLATrT EEWNOT'ES k t Z k� 3 . � 1'Ir�Catitioiialeirl�G o,�ll�`�sstt�cfir�s�lfs � 1 �. - _ - De�inrl��teittorfl'uctrrsfefirlEicci�lerrts t��0��frSt'ltrj�fQ[Fa�fr 4$f � Bl#Sfo1P MA V21,11 `` I[rititt�.turrssgotlfiirt �t'o>,trcet's'�Cane�ieti5nt�utc�tts�Rt�n;Ct���fc1'€tcrlt:Bi[�titctslE,�nfittt:tors�let`fticin�isl,�lit►el��e1=�: 't►sI['eaflElflt�olitt[tlili)f /+ =PTe•st:Pr i{(I."'w � I £ttti��fi[u[esc�Dightii�itio(n(1Jttditidual} j f T�l/ �� j��S t Arc i itiirtd}•cr?eficertfilenpiii•trl1[•ttttebox: 7�pt bilt[ojceCtret}[ttie�t); 1: E ttpt it eut to crc�idi,_ ant[[general cbntrttetorttuti 1 ` + No1E C6iistriiFtion i+uipto}ccs(AW fudlorpa[ t'iiuo},�- CFnvohIrcdthcsttb:coritrnclors 2.OZan[cFsoIeproprictororttnrtncr listed`11thenitncitedshm.= 7• dnemotte(ins ship aucThavono cfuptogecs 7ites sub•cotitrnetots linvc S. Detitoll(ioie f nioticing for NOfix anycapnctq'. %vockem'cotup.tasitrnuee. [Afo%eoiL-cr `colnp:JnSttrauce $:❑Marc aco[Itorntl6uand its ❑'p�ittilingndctitiort oOcersbn�%cc�eresectileir J�� Ieclricoliepaltao[nfiditioas. .❑I;i1m.aCioi[ieoutiertltii»s'titl�Xo[l: r�aht'ofceeauptionpct MQL1, ,1'rtgnlitug[titaicsornt(tlitiolt5 114teir(No•workcr�Coutp. C.JS2i11(=1) tindtlOI, •ci[o iftsurnncerc aired. t e{fi Flo'ces. l2,[(Roofrepntto R � 1 J Y [i�to:i►orteis' i3,[('O[Ttcr j cgtnp.Gtsur�utccrcgalred.] tip}i+tdic t[(6•Feti;<tx[ImulInilr"tsofiifcutt?: ce[i�ataoustw►tisirUr:irnrsiu�tuiufca�3GonraliyS�Conuifia ' -C61 ''tcsn;anti:isN-itc+suirnfillidsraics�citfnrlir,.ti,tylccptrdoatrrltti•.�tkrnd[qea[tire6ntstdtf�yttrtaoisttinrtsurititnh�»p�tTdtRil[nJica7Tn�sut6. tCbnt� QialltlCcit:.+aP,�tvsita;ta'facixdonraQiiiovl[sl astfatr6i;{[F:�tunte fFStstih t.tticinGdgs;ittiieitcr's a+'vp.�'�[ieyLtCauuU'm:r. IRI!%plt•FI!%f/fel`C'F(CrR(lSfrlO{'f(if�Pfj[t'Offi@FSrCUll�ll'r(5RIf0(IIItS(!/Rficef rup,einpfU1C@5 IJefowlrllicErolief°ntr(ffoGslle�� ! IiarnrRllon. IftstfritnccConq#an}Triuirf�� I .Policy fEorSt3j0 i(ts Lic.fl ittitin iite,•. �� l v , J6vsitellc�ctress _-.�t'� C- ► �,[}fStatc7ii}�:.. � A.ftnelt0 Copk,pr(t[otvor[tet•s'cotu1iensitllott1aD1i�3 kicclti[ntfuupnge[sJtotis�ngtlretioi[eS i!tui[l�ern[tdCtJl[[mftdttitiife): rti[Ittrc lasoriurt Cot'erttg63ts iequtti dtnteterSe6tiotiS/►of JVil3I cacl:fo tiic iitipos[tiot>9fcrnnitmtpt unfdcspl a Y fiitq tfg fo:Sl,Sbp.QO andPoronGyeat ifnp['rsonnlent,as well as civil penaltics:In 0116 torn[On STORWORIC O t));[t[iRtf a ficiC i tifup to SZSO.tJQ n day agafitst the vt`ota[or. lac ativiscil tltati[cop}•oFlLis statemcfit iiia}•fae foni acit6tl to the0l6ee of tttvestigaiious.oftheDIA for insura teecoverngeverit[esliou. Irintrerc•Gj�cerl •rrrrrle+rlhetrRlilcar(rlJrrrttrlllesn jwfuzvlmttliatrf IurtbrtJjr'oirtcrlr(bai-lstitle tr(lf:'crfr�c•t! t) to � c�•� �'� �G( � f1.f'cTcrllrn oli(ii/10110!1t'r:l(d!frtllrIsareir,tofaroll Itehr7L{`Cf�i'arlaiv�(ajjtcfrrP G�f�or o"s,: YctltilffL;celistslf' tsffihig Aiitfiorttti;(ciI-cte oiiej; t I.J3�ntc1:of I1e;tiEt( 2.Roi[Jing I3epnititicut 3.Gif41I of+'ii Cietk .Glscti IcatlnstxCtal° 1'IntuGfug irrs)e [ot 6.Qtltci • CO .6t I'Iiolit ft. hiformatwo and Ong 14�assctchumettiOckerdLtttts chapter JS2 re,114 es a lte1hploy_ersio,31-tow defers'solp),ti tio4 for theirernpToyees.. Potsudattoilkkstatut%:aneiry7OV� .i tfefiiled:ts.`:.,Yi;�ei7tperson ftietseniczofan.otheriiniter ttyconrractofitire,, ospne s orhitplied gnat of 117i�te11.'F fite�tplo}eeisde'i etlas"aginilivitlltal,paitilelsliip)A'S106Iatiotr,WpOralionorother-11g6Ie,itjj otra4jrtlVo�4r1ii0re oEflteforagoingeilg�gectnlia;�oineenterprise,a�ii�iu�lildin�the:legati�prasentatic=cs:ofia tlecease�cmpt6yel;ort7ie t'e�icetortittsttepfOil utdi0d(lal,pattnershi��•nssoci7tian:orotlleriegal'e11(ity;ctit3sto�'ulg;cmpIa}iees 7iotveterEfie ovrnerofRrlvvelffitglioiise.liaving110fJabitthantht apait,ttenis:and'ivliordsidesdiereiu;or(lie occupantof'tile clirelfipg ttousaofanother a=Ito etnploysiiemous to:doamarntenance.,constriction or opair�torl:on&ucli cttv811ulglloiiso �r pp'thbgrotneitsoxbnikliilg tlJtpurtenauf titereto,slialFuobb£cmrse•ofsuch.eiupio}•ntenf GedeemecYtU Ge.foi empla}=e�" WLclfapter152;-P•3G6 also-slate sthat'``asQlytstat�0i0aTileemsilIg6g£flet=.shit)CwithholT€heAsstiatteeor atety it,li n IieolisC or iiermitto operat£a GI 0' to eotisFt iscf btilldiugs in fire colmittoinreaftl�1oi atf} :rtppliraut�v)a�)�as.liot prpdueed nccepfableeFileftce of'cou,liliamce tvifit.tiiei,rsti,•iiucepoveL•:�ge 1"e(jltire{l." Aciditiouall};h�Gi:�ifpterl52,�25C(?)states ither tileconinLonlvealth Horan}-ofifs paliticai subdivisionaf Lal! �,;ter iuEo any contract or( r tilepeifomfattce ofyublig ivorlcuntit acceptaGTeevidenceofcompliaucetvitli iliFinsuranee retiiiirc�itenis oFttis cltapfEl'),ave lt;en pre;iattecl to the contracting autltoYit}:" cditls Pfeaseftl[ouf_tllgi�Oticers'�onl�tetfsatioufl�ficldl>>tCtitrtpTe<toi , 3 �. �'D'•�Itecti,t't�le�toxesilttsfappl}'f4�yottrsitnati6tLnitti,if • ,11eGeS$fl' SU l°sttG-conCracfor s itatue s address es and honetitntib$t-(s)alottgaviththeirceitific?te s pP insdra,tm LimifedVAHify Compatiies(LLC)or-Limftedli fabiGtjlFattiieiships(LLP)Svith no etitpfopePsotlter'#li8tr:tite iientliersoiparfners;are notrequired fo .ate workots°cogtpensationinsutflnce, IfanL>;CorLl,Pcioeshatc :otitployees,apolicyistegmired.-Bet+dvised'thatfhisti(fidavifulaybesilbmittecitotheDep,tifnlentof industrial /kccide,ifxforconfirnlafio,lof'iftsutancecoverage. AtsobeLsuretoslgnnitd(late tltenffldat=!t Theriffidav4shotttd ' be returned to tite city or town that(110 applicatiou for the pe,ttlit or license is being requested,trot t1►eD£llartnteuf of Fndusirial Acciilehts. Should you hat• aopy'gnest�qus regnrdimg.the late 0c if yroii are regteired to•oUtaitt a�votkcrs' ' pat1ipef5tationpolicy,please call file'AdAoffineot,Ottl,emnitber:fistedbaloty. �elFlnstued.co,ftpa,tiies_sltoutcfentertilcir calf insurance license numberolLtheappropriatc line. Cttt,01 To OificiaT,s Please Gsiifetli�t#henffiitavifiscotiLplet€attci.prilztetl:iegibiy. �1ieDe aihftentltas ro. ` offfteffidavitfor =oftfa ill' p p v,dect?FliticpatfGobotttint f ontin 1 3 t teeveifth � et)fliceof intest�gations l,as fo cotlfncCynur?g:�.t-cluf�iheapplicant, Pteasebe sore to fill in thepenmifli ecnseLpmtberty]licit will.bausedasa:referened-ipmber. In adciitio►t,annpplicattt tYsaf musisubinitnudfipleperutEf/iicettse a licatiorisin Oily _ _ .s pFgneilyea',tteed'onl}sttbmitoneafhdavitindicatingcar enE f i jiolic}j infonnafion(ffnecessary)and iuc#ei",ioU SiEallddtess"tU£appiica�it'should ivrfte"af[locations ht (eff=or ; f nfqii%li)c.a°nAtacsppry oflheataffidavit tl-taflas•b-ecnoftcialiystam edorniarkedb}the cit} r 3 t01171 uta}be.provided to the i 1p p ooffltatatralidot'ttdatitisotiiileforfiifure erm` p tts or licens es. A tieda idavitnus[ie E filled out e.•tch � ve<�r. lt'ltere a honte btivner or citizen is oGfah2wga jicettse oto pernilt not related to anj=bus,ie;s or commercial vantuie a dog•license ot'permitto burn leaves etc)said persoitisXoTreclukccl to cotnplefethis tiffidalit. 'lltedo not t�AfCQofliW figafi0.13Nvol11dJiketofiij=o�rinailvanceforyotiico 4�eriicjnitttds�ottlnyatiitaiati}gtiestions, pYEitse lecsifaf£tagive 115#1 call: - - f Titc De ati,, �' 1iin. t sat d e fele.Pl,vtlealul fax ut,utT?er: II The Co�tung�Lt�tl�tit ia�i��t�ts�r.�ltcfsetts f .Be1iarfineat of Jgdusiei41 Aeczclattts j Office of f1lVe.$tigAfsoll� 60U•ZVasiitigtbfi Sheet ,BoS1011,I%01111 l Tot#617727-4PQQ eKf-406-ot'1-$77 I1lIASSA*pB � Iteiuiseii 5 2G•i14 �f���G7�7�7 fi7�9 Date../ NORTH °f TOWN OF NORTH/ANDOVER 0 • PERMIT FOR GAS"INSTALLATION SACM ,This certifies that . . . 5 . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . w .` . . . . . . . . . . . . in the buildings of x-.s. . . . . . .. . . . . . . . . . . . . . . . at . . . :Korth Andover, Mass. Fee. ;? Lic. No..F ?3. SPECTOR Check# 7'106 d f ^ MASSACHUSETTS UNNORMAPPLICAT'ON FORPERMTT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,,MASSACHUSETTS Building Locations �`� Permit# Amount$ Owner's Name New❑ Renovation Replacement Plans Submitted U w W a p U E� x w a a ° z z z O `n w . U W v, R; O w E" W U x C4 H z H ¢ x w x W a ¢ w ¢ �" `� z o w o w H x O x w j 3 A C¢7 a U cx > A a F O SUB -BA SEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8.TH . -FLOOR (Print or type) Check one: Certificate Installing Company Name _ / l fi�� >° / ❑ Corp. Address d U/1--J Partner. usmess a ep one -p -A--Z) aFirm/Co. Name of Licensed Plumber or Gas Fitter ` Xel~ X-it,, r INSURANCE COVERAGE Check one- a have a current liability Insurance policy or it's substantial equivalent. Yes M, No Ii''you have checked Les,please indicate the type coverage by checking the appropriate box. Liability insurance policy 12' Other type of indemnity 0 Bond 0 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: gent Signature of Owner or Owner's Agent Owner A 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 under Pe t Issued for this application will be in compliance with all pertinent provisions of the Massac �ss S e Gas Cod and Cha r 142 0. e General Laws. By: Signature of LiccWed Plumber Or Gas Fitter Title [3'flumber City/Town [:] Gas Fitter License Numer 17—Master APPROVED(OFFICE USE ONLY) 0 Journeyman f The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston, MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambgrs Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?.Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12,❑Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.0 Other Any applicantthat checks box#1 must also nll out the section helot»showing:h-ir wo;;;ers-compensation policy infor -tion. 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 workers'comp.policy information. I am an employer that isproviding workers'compensation i information. nsurance for my employees. Below is the policy and job site Insurance Company.Name: Policy#or Self-ins. Lic.#: Expiration Date: i Sob Site Address: City/State/Zip: y Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sip-nature: Date.: Phone#: FFthh only. Do not write in this area, to be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with.no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the perixiitor license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to.obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a-space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given.year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or 1 town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211 l Tel. # 617-72.7-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass._gov/dia t Location S �h�Sriyv� S� 3 !� No. J Date 3 MO�TM TOWN OF NORTH ANDOVER 3? � r• �0 AL 0 9 ` Certificate of Occupancy $ s i �SSCMusE�� Building/Frame Permit Fee $ 00 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ + Check # 17129 Building Inspector TO`" OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAY RENOVATE, OR DEMOLISH. A ONE.OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 61 DATE ISSUED: _ ` D X C SIGNATURE: C Buildin Comrnissioner/I ct of Buildings Date SECTION I-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �t5 �LiESN�T Map Number Parcel Num er 1.3 Zoning Information: 1.4 Property Dimensions: V(�V V Zonin District Proposed Use Lot Areas Frontage & 1.6 BUILDING SETBACKS ft Front Yard. Side Yard Rear Yard ReqLWred Providered Provided R uired Provided - Q 1.7 Water S ly M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public l Private 0 Zone outside Flood Zone 0 Municipal 8 / On Site Disposal System. ❑ J SECTION 2-.PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record r -2sT— �-• Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Nam Print Address for Service: m Si natal Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number on 4ddress -t7 ( Expiration Date v re Telephone r i.2 Registeared Home Improvement Contractor Not Applicable 0 C rr.Jc .ompany me11 m ,5,w .zr �✓c � ' � Registration Number i address Expiration Date re Tele hone SECTION 4-WORKERS COMPENSATION(NLG,L, C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and subinitted with this application. Failute to provide this affidavit will result in the denial of the issuance of the buildin rmit. Si nedaffidavit Attached Yes....,,, N.._.....0. SECTION 5 Descri tion ofPro osed Work check all a licable New Construction 0 Existing Building ❑ Re s PauO ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition 0 Other 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beFQ Com leted b ennit a lican 1. Y 6 'Building t ¢ (a) Building Permit Fee 2 Electrical 6�0 Multiplier (b) Estimated Total Cost of 3 Plumbin Construction 4 Mechanical HVAC Building Perrnit fee(a) x (b) 5 Fire Protection 6 Total 1+2+3+4+5 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 My behalf,in all matters relative to work authorized by this buildin to act on g permit application, Si uahire of Owner SECTION 7b OWNER/AUTHOR''IJJZED AGENT DECLARATION Date property ,aAuthorized Agent of subject Hereby declare that the statements and information on the fore and belief going application are true and accurate, to the best of my knowledge k Nov �� ,� �►y Prin e Si ire of er/A ent. - —./ Q Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1• 2 SPAN 3 DIMENSIONS OF SILLS r_ DIIvIF,NSIONS OF POSTS : DI-N ENSIONS OF GIltDERS PlE(GF1T OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID 0R FILLED LAND IS BU -DING CONNECTED TO.NATURAL GAS LINE • r The Commonwealth of Massachusetts Department of Industrial Accidents t� = = l office 011flyest%yallefts _ 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name loc ation: Zi 1 ;Oew I 17 A[J�� X i7Nd tJ£-2 phone / 7d" 69'/ C] I am a homeowner performing all work myself. l L?l am a sole proprietor and have no one working in any capacity saMIRe, ii F-1 I am an employer providing workers' compensation for my employees working on this job. company name iddress. city: phone# I, insurAnce co. apolicy# FJ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comnanv name. _ a dress• X. city: phone# insurance co oltc # e company name: address: crtyc phone# tnsurince 6. policy# AtF�r„haddrtronalheeHle essar� a -^-� Failure to secure coverage as rcquiredduunder Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 31,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the its and penalties of perjury that the information provided above is true and correct. Signature Date 3 -L6 -,Q 7 Print name ^1 `? •CGS. ..... .. . . .. . ._.._ ._ .._._. . ' --. � Phone#' 1,ID � SV t{ kLi,i.h.'�:.",.YYJ" 'r': 3L ...::S.ms,x'�i.• ... _, F. official use only do not write in this area to be completed by city or town official__.... city or town: - permit/license# -Building Department check if immediate response is required oLiceimingBoardpSelectmen's Office C]Health Department contact person: phone#; -Other '-`sua.d'^�.:1r. >.. • •' YE:...a..ut:=AJ• ,-. ,.n•.. ^ <.';»mc,r..v::,..5e:C .:_SSizt: (revised 3/75 PIA) i • - ✓fie �anvmonu� o��/�agaaclu ` ': [ i BOARD OFBBUILDINGAEGULATIONS I x License .GONSTRUCTION1tSUPERVISOR d NuM erl:-C°S 058245,:;` Birfhdjte ;03f24/1943 i -x Expires 03/24/2004 Tr tiQ: 20021 - Restricted` 00 KENNETH FB KEEN ; 21 HEWITT AVE N ANDOVER ;MA 01"845- Atl�lilli lator Board of Building" g Regulations and`Stiindards HOME.1 MPCONT RACfiO'R Re istratlon9 108383 Exp� aro.n 8/18%2004 Yp KEEN CONSTRUCTION GO Kenneth=Keen 21 Flewilt Ave No.Andover, MA 01845 AttmW t israfO;r i KEEN CONSTRUCTION:CO. 21 HEWITT AVE: N.<ANDOVER;IVIA 01845 (978) 691 5201; r, Cruickshank;Donald& Christine 4913radstreet Rd.' N. Andover; MA 01845 (978) 685-0539 Contract#:1482 ; Appendix A Date:2/23/04 Remodel bathroom: * Demolish& dispose of 29d floor Wthroom`to studs except ceiling (unless necessary) •' Fatten wall behind toilet to receive standard toilet(12",o c_) • Build wall-;at end:of shower • Rebuild-existmg closet as necessary`to nkall;new door •,' Supply&install customer selected.ceramic the_'floor over existing mosaic:tile (if possible) Supply&`install;insulation& vapor barrier on outside walls Blueboard walls;& ceiling ,skrncoat plaster to month finish • Supply& installtrim on doors,window&base to match existing. Paint' &'trim'(2 coat finish;2 neutral colors) Electrical: Supply& install"customer supplied fan/light combo( additional circuit for heated unit wil,f e charged'accordingly Supply&install switches &,outlets to code • Supply.& install 41 or 5'electrical baseboard(whichever is deemed necessary) with integral thermostat Plumbing Remove&dispose of all existing brass piping;lead drains associated vuith bath Remove:radiator. cap radiator pipes in floor Supply&,install new d • rains,vents& feed pipes. Supply-& install new fixtures selected by customer at Peabody'Supply Total price.: $17,800.00 (seventeen thousand eight'hundred dollars) Price does not include costo permits, excessive work necessary to install ceramic floor, or.extra circuit for Heated:ceiling`vent. 1 KEEN CONSTRTCTION'CO 21:HkMTT AW- N:_ANDOVER MA;01845 e (97;.8)69t 5201s 4 Payrnent.s�hedule $1000 00 due upon signing contract, $5000 00 due the-first day of work 4000:60)"e,when fixtures are.deh�ered to�ob $200 00 due when rough electrical&.plumbing.are done $3000 00 due when blueboard is hung $2300 00 due upon completion`of contracted work; Customerenneth Kee � s Date Date:- ,u 2 FORTH Town of _ Andover 0 �� dower 1Vlass., .3 MOODY T Q - LAKE 9 COCHIC H WICK ADRATED 5 S V BOARD OF HEALTH now ERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.. ,�rtS....��'� v �� .�V t S �N ......................................... ............... ................... ............................................ Foundation has permission to erect.R����~ buildings on Shy•� � ....., Rough ............ 4.............................. ........................... R ' Z.A.tWoo Chimneto be occupied as.. . .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 -Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. q%474 411140 r■. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMU EXPMS IN V MONTHS ELECTRICAL INSPECTOR UNLESS V LESS CO �f STR C 1 O V STARTS ALTS Rough AA 4 : .. ....................................................:..................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 1482 KEEN CONS'T'RUCTION CO. n 21 HEWITT AVENUE P 'US 'A L NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors engaged ' In home Improvement contracting,. unless Fax: (978) 682-3231 specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with Submitted {} ( �, (� the Commonwealth of Massachusetts. Inquiries about ff r (,.'' ,/ To. ............... t�_ t.`� 1 fl :......_.� --- registration and status should be made to the Director, 1Home Improvement Contract Registration,One Ashburton . !._.__.. -fi r:t - --- + :—•.---.. Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related .� J t,vt�' ( (�_._ G'l L«{ _ permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. F.I.D.N0. MA. H.I.C. 108383 04-325-8052 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: _. - ...._ �5 c � C)_P� _� . ._/�_...._-_. _..__ _. ._..-__._ ...... __.__ _ Construction related permits. ..............................................................................................................._............................................................................................................................................................................................................:.................................................................................................,............. ..... ......................................... """............................................... .....,............................................... ....... ........ ..... ...... ............. ................... ...................... ......... ................... ...... .................... .................. ................................ ................ "................................................. WORK SCHEDULE Contractor will npt_begin j e work or order the materials before the third day following the signing of this Agreement,unless specified here in riting. Cohttractor will begin the work on or about _.> �� / 'l (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by — (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of i following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contracto,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications, for the sum of � i `� t(f OF t'1 1 P<' '� a u 5c .�'t � I d red —.--ciolfars($ 7 %% t)G' C' C-, Payment to be made as follows: )- ($ ) upon si ni Q2Contr et KENNETH B. KEEN \ IN Name of Contractor/Designated Registrant ($ " n completion of 21 HEWITT AVE. \ Street Address °X (�$ ) upon completion of ANr'30`�iEl�, aJIA 01845 City/State % shall be made forthwith upon (978) 691-5201 (978) 682-3231 completion-of work-udder this=contract-= -° - - _ ._-Phone .-.:_--. .: _ - �� Fax Notice: No agreement for home improvement contracting work shall require a _ >down payment(advance deposit)Of more than one-third of the total contract price Name o!Sal or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of,special order materials and AytgGra sign. e` equipment,whichever amount IS greater. Note. This proposal may be withdrawn by us if not accepted within days. Acceptance Of Proposal -I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the-third business day after the date of this transaction. Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. t .� Signal( 7" Date � ` Signature Date IMPORTANT INFORMATION ON BACK Date?... .. .... .. .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSA US This certifies that ..../�' e .J..� .............................. has permission to perform .....9ce 5-fool e,7— ............................................................. ......... wt.ring in the building of..........19 .............................................. .........d. ... . at ...... ..... ,North AVndove .ass. .... ........ Fee...3�............ Lic.NAW. ..;.... ...... ... .... ..... ................ 1�� > F Wl��;;;:i:<ECTOR Check # 5091 4"`r Official Use Only Permit No. y D0-ft-a ;V`4"54w# Occupancy&Fee Cheeped"`— ` BOARD OF FIRE PREVENTION REGULATIONS7 R 12:00 APPLICATION FOR PERMIT TO PERFO . ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 5 -Z-'/ ._6 To the Inspector of'UNir es: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Y,/ROwner or Tenant ® �p �- Owner's Address is this permit in conjunction with a building permit Yes No 0 (Check Appropriate Box) I Purpose of Building Utility Authorization No. Existing Service Amps t/VOits Overhead Undgmd W-e� No.of Meters / New Setfvice Amps Volts Overhead 0 Undgmd 0 No.of Meters Number of Feeders and Ampacity Location-bnd Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Matures Swimming Pool gmd 0 grnd 0 Generators KVA �n No.of Emergency Lighting No.of Receptacles Outlets v No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Bumers FIRE ALARMS No.of Zone Total No.of Detection and No.of Ran es No of Air Card Tons Initiating Devices Heat Total Total No.of diposal No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained No.of L' ers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices. KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases W. No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws y� I have a current Li ility Insurance Policy includi Completed Operations Coverage or ifs substantial equivalent =NO have submitted lid proof of same to the Offi =NO - If have checked YES please indica the type of coverage by checidng the appropriate box. INSURANCE V BOND - OTHER (Please Specify) Mt.' t(/e[ (Expiration Date) Estimated Value of.Electrical Work$ Work to Start Inspection Date Resquested Rough FinalSigned t� 1 FIRM NAME under the Pe flies of ry"u 1G4 C/� .� Ic- Ltc.NO. � lq ,2 2— Licensee /�/L— Signature LIC.NO.' P,/// �� /2 �Ol/Z°�Lt -,,/ a3a)`�Bus.Tel No. T;7 ,Address Alt Tei.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts ,enerai Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ 1 (Signature of Owner or Agent) Location No. , Dal. Ln TOWN OF NORTH ANDOVER Certificate of Occupancy $ 4L Building/Frame Permit Fee $ % .. S Fo lion Permit Fee CH $ Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ J�e Building Inspector 9477 Div. Public Works Location !dS L" ch21' No. S Date 2. x ; .� ! ?aw,r°T ,yo TOWN OF NORTH ANDOVER ,.y a ' ; Certificate of Occupancy $ Building/Frame Permit Fee $ i �� °''•°''��� Foundation Permit Fee $CH .W k. Other Permit Fee $ j Sewer Connection Fee $ Water Connection Fee $ tv TOTAL $ 35Z� Building Inspector ,a 8813 Div.'Public Works- Location 4S ` o/ l I No. Date M°arM TOWN OF NORTH ANDOVd �G't•�•o I•, 0 o _!I ' - p Certificate of Occupancy $ 0 Building/Frame Permit Fee $ 41 1Ss�cNu3E`� Foundation Permit Fee $ i[. Other Permit Fee $ �7'j Sewer Connection Fee $ r � �f Water Connection Fee $ �D7T.lta o TOTAL $ a b j Byildi Insyaetor ,= 8936 Div. P bli Works Location- Dat ocation No. `$ Date A Sr t TkORM , TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ C MUS Foundation Permit Fee $ 4 SAE< Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ JZ3 � G� 3�� 1 Building Inspector 09/20/95 15:23 150.00 PAID A Div. Public Works PERAfIT'Nb,,, APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP AO. I LOT NO. 2 RECORD OF OWNERSHIP IDATE - 20tJE ..� SUB DIV. LOT NO. uv4iTWl poRiSN �•�� 9I 4 I fL.�4t i25� LOCATION l !� �`�' /1 PURPOSE OF BUILDINGOr4v—z OWNER'S NAME � L•, 1 ""r' NO. OF STORIES ►v SIZE D,t�yiD M�Rr�iEJfi�ci� - 2} ,a►G s� OWNER'S ADDRESS i c �� ��„�i`` �'^r _9 c_1.� BASEMENT OR SLABc,� e ARGI""41TECT'S NAME � l (VCCN4 �•?� SIZE OF FLOOR TIMBERS 1ST�'1 ti I O 2ND-j v tD �R{w��+�1 p_ BUILDER'S NAME •t>4Chji/�� { ys C� SPAN G� 6.•/• C7 DISTNNNCE TO NEAREST BUILDING �1 W J DIMENSIONS OF SILLS 2-2-x 1 DISTANCE FROM STREET POSTS1�Z 11 � Ib l.ai_4 CoLu-441, $&-,-EME4T DISTANCE FROM LOT LINES-SIDES 3`7.82asEAR �l Pte• GIRDERS AREA OF LOT 43sc33^] eld ��f�• vFRONTAGE 1!(�l�I✓ HEIGHT OF FOUNDATION '�I1,Q`� 1f. THICKNESSloll - IS BUILDING NEW yjE� -[ r L SIZE OF FOOTING '7444% e ` X IS BUILDING ADDITIO1NG._1.� MATERIAL OF CHIMNEY t oor (_M bi-_ IS BUILDING ALTERATION �1s� a IS BUILDING ON SOLID OR FILLED LAND r4o WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �/ IS BUILDING CONNECTED TO TOWN WATER %(eS - BOARD OF APPEALS ACTION, IF ANY %(F IS BUILDING CONNECTED TO TOWN SEWERC� IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION PERMIT FOR FOUNDATION ONLY LAND COST 13-2-)000 SEE BOTH BIDES REGULATED BY PARA. 114.8-S. B.C. EST. BLDG. COST .PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. ' 1 PAGE 2 FILL OUT SECTIONS 1 - 12D �� EST. BLDG, COST PER ROOM ATE FEE PAID 17 SEPTIC PERMIT NO. , `ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR pwi+l • DATE FILM ✓-� (�� 5i5 — BUILDING INBPSCTCR Q�Q SIGNATURE OF OWNER OR AUTHORIZED AGENT - qR F E E —' PERMrr FOR FRAMUBUILDING OWNER TEL.# ,PERMIT GRANTED CONTR.TEL.k SO$-725-�30 19 �� ATE: A*EE PAI D� l3 0 3 CONTR.LIC.# 05 H.I.C.# SEP 18 I005 _¢ 34719 X88�3 r BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S�oRIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFlces LOT- LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ d 1 2 13 CONCRETE BL'K. PINE — — II •• -� '13./J7.GG'�-9s,.• �� . BRICK OR STONE HARDWD PIERS PLASTER L,{•' +�� i t' '.• DRY WALL ' UNFIN. � �\ ' + 231 r I . 1 3 BASEMENT I � 1 -<.:v AREA AREA FULL FIN. B'M'TAREAv _ r FIN. ATTIC AREA +•�, + � fo p '� 1 I \` NO B M T FIRE PLACES HEAD ROOM _ MODERN KITCHEN 4 WALLS I 9 FLOORS ' /, CLAPBOARDS 1 2 3 - DROP SIDING CONCRETE WOOD SHINGLES EARTH --� - {/ - •♦ ---- ASPHALT SIDING HARD"/'D ASBESTOS SIDING COMMCN VERT. SIDING ASPH.TILE STUCCO ON MASONRY CF_ft--r-Le STUCCO ON FRAME ' 4+ i BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME 3 SH££TS d�pf. %LIDI j I'' • ,H /�� u,�y�� CONC. OR CINDER BLK. i": STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR POOR _ i: .` ' ? 1 1 444 •.1,.,. � ADEQUATE I NONE '• i►� 5 ROOF 11 10 PLUMBING (••. 1 n �,T IY rY�� GABLE HIP BATH (3 FIX.12 57 GAMBREL MANSARD TOILET RM. (2 FIX.AAL I FLAT SHED WATER CLOSET _ ems— _ •' '�':I.I1 - ASPHALT SHINGLES LAVATORY _ 'I 11 c �• 1 �. WOOD SHINGES KITCHEN SINK .F : �� 71 -� .:1.• SLATE NO PLUMBING Cli TAR & GRAVEL STALL SHOWER 719((�� NJ( ROLL ROOFING MODERN FIXTURES .� ' - •/F`S^'`.,�, � ��� TILE FLOOR re�ror . 1 _ •�'_v}- t) �_�q TILE DADO t 6 FRAMING I 11 HATING �'t�_J'CHfIST� ut4 WOOD JOISTPIPELESS FURNACE FORCED HOT AIR FURN. + ?3i ►,• j RiN.=ni TIMBER BMS. &COLS. STEAM �wr..us.es. ce Rir ne.+ jiMvtet out ve o, STEEL BMS. & COLS. HOT W'T'R OR VAPOR �' ,`�'�•s \ WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G 1' UNIT HEATERS 7 NO. OF ROOMS GASOIL 2nd _(P ELECTRIC Y �� 1st 7 _I 3rd I0 11 NO HEATING NORTH ToVM o Andover 0 No. .459 dover, Mass., S�� 15 —lgqv 0 LA� or. coc'I'cHE 'C n AERATE D C.) BOARD OF HEALTH Food/Kitchen PERM .IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.7W%P......�e, 1PL.&-t'U-rA................................................................................. Foundation has permission to erect.4)=....F.000:e... buildings on .440.....QW-1--mur......SlIr.......................... Rough to be occupied as.2kk-1fx.LL.....Tivn.I WiF,*D.oft. kl 646..... . Z..(?A.R .....04APA(:&_�rn................ Chimney P that the person accepting this permiAshall in every respect�co/i'or'm 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 Inspect1R_RN1trP8LMMfflbAC8WVf Buildings In the Town of North Andover. REGULATED BY PARA. 114.8-5. B.C. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough I PERMIT EXPIRES IN 6 MOfff* FEE PAID Final 5�z c/o ELECTRICAL INSPECTOR UNLESS CONSC Rough ......... Service BUILDING IN CTOR Final Occupancy Permit Required to Occupy Building )WINS g, i •� Display in a Conspicuous Place on the Premises — Do Not Remove Fin No Lathing or Dry Wall To Be Done ;5�' FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL V Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary ' approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: yO� N1F$MELS'TF_ITA Phone '508-72.5-3Co30 LOCATION: Assessor' s Map Number M�T_6'5 '-6T 4` Parcel Subdivision Lot(s) ' Street C_-Weu`j St. Number ************************Official Use Only************************ RECOMMENDATIONS /OF TO AGENTS: /) Date Approved ConservatioT� Admrrinistrator Date Rejected Comments - Il��nA. JC c.% , Qt = (1Slt���,,��SJ; �( w0silz fe) R� (,-e, Im. `t. ha 4�-w¢a II iJ 9(V•56 Fes. VLt Date Approved Town Planner Date Rejected Comments hareCom► "Pft iq Date Approved • Food Inspector-Health n Date Rejected Date Approved �Ir � Septic Inspector-Health — Date Rejected I Comments Public Works sewer/water connections - driveway a�permit t Fire Department r Received by Building Inspector Date 96618 1 d�� OF M?SSA DAMN / r.I 11% 1.,Tr:! DESIGN ,'jc 1'. '1 ' AND .�►T� PEG 140 113164 u' q � CONSTRUCTION INC. M lva '4ISTF �r �VCT101J COMMONIMEALTH DEPAFTI FA ENT OF PUBLIC SAFETY OF 1010 COMMONWEALTH AVE. @,d MASSACHUSETTS BOSTON,MA 02215 Lf I:':Ehi' ;F- l.' . C'- Ii\I'.=:TR. EXPIRATION DATE `'•'" ' I RESTRICTIONS I EFFECTIVE DATE UC-NO. P52 5o' T , W*m m p o EIAV):D I4 N,FI nl r9 2w MN M,TMM I�n l rl' (.1:x:(:1•-4•:r.—._'.•�`1••j. J Bco PHoro(elAsrlND oPR ONLY) FEE: , ,,�•'s•. NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ,E ~ ZK :� �:;. HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: `iK�.✓`. ,�. �g Cj n�M,N W �7�Qo Y � .�` y THIS DOCUMENT MUST BE tj AN a�J� EQdZ9 '__ " ILj� ���"�.p CARRIEDONTHE PERSONOF v SIGNATURE OF LICENSEE, 8 ?:,tt1,.a�,,}i�r+�i�'„ THE HOLDER WHEN EN- /'j'�y^ ' U"Ol m : h "r. i'i`��yy\C / ,f`��,1�/.� C�N�� ` �1T1 OTHk'A$Y{Sp{T�)({iUMB PRINT GACEDWTHIS OCCUPATION. ls'-- _ A 'F'W)V.. G11_1l H - --- .arm -color a��� HOME INIF'f;OVCNICJIT CONTRACTORS REGISTRATION Cc -ard of ^uildiiregulations and Standarlac One Place - Room 1301 Boston . Massachusetts 02 106 i;OMC IMPROVEMENT CONTRACTOR Registration 113164. Expiration 05/20/95 Type - INDIVIDUAL D14VT.G i'i1'Rj' L;. 'IhJ 5 CLARK STREET —' WALTHAM,MA 02154 617 893-2277 �� ( 8 FAx 893-7795 \ I NOV 13 9 Q- 1, 0 1 t' �3 � 1 QIN ►1 "o r .. G IS .s/EPF�Y CE,cT/FY TO Tye T/TLE 1A1S!/,eO.,C ANO /�L Q T RL 4AI T1� Ti/E BR,V.t' /S Gae,4TE0 ON rWe,'OrAf SiSC/YN ANO Ti4GOT?ODE'S eawcz ew /N IrrrN r//E ro— Oie',vo, o voc B,e zON/.t�G c�E6!/LAT•t�,v$ ,F�6+�,eo�.�rG sErs.�crs F.eo,H sreEETs!Gar li,�E-S.� �0 /9�(/G2JYE.� /y�,gsS, I F!/.�T.YC.0 cE.�T/FY TNiIT T•f�/.S OM'ELL/N6 /S it/OT LOG4TE0/� T,YE FELIB,P.4G F,COroO .�f•4T4.00 A.PE,4. O,P�i�✓/V /rOiP �lawN OiG/FEiw.t' Cp,a,�,c/t/NiTY P.I.VGG '� 2.SQ098 4Gb6 C boTgp 6�z�q,3 S. P.L.S OATS H0 NN Lag sSla0 /1 .P.P/i!l•9Gf' suRVE'�p 66 -4•P,E�..s7.rEET or'e° 11,4A'lOI�E.� /y1.4SSAC,fQ/SETTS o/8/U - � 1/ �' r �1, �,3•��, I 1 .'E I X11 ,� U : ._ I 11 - . coo `. 74.: a If of 2-3/Z Z-o 3-3 'St 3 �Q 18 i 8 5-0 -Vk Z - PRT e 7-71 Ro=3r}x53%Z , - Ko 34x53%2 Ro Co9%ZX53'/Z Ro 3ax4i�Z =3ox�}I%Z RoSox 41 Ro=�9%zX53%2 - TO 43 dt -- ri { _O r 4. _ INE ( = �� 0�1o1�L i Nq N �+ 50ISE. l\i coo ! 0 4 \ -40 IL orT�c. 9' 12'r e - _ Gt�E'1• r I Leo I L 11i a a -- - - —O ! — --- — X 24(08 _ __..,.. _, • � J 6 1 PSS -: _ ot� 10 lbkl ' - _ �Er� Root�'1 M 3 q ITT C� [`� i RDoF t,rrlE P�IDhJ ! _ _ — W4Ll. s CD'(p" A.�l _ � \ k . Rp=34u`53h R.o341x53/Z Ro°3 4x i S3%2 Ro34 !x 63'/Z RD-34,' 53'/Z� � m 42(+ 17 1 �r E I 11 - .1 �+ 11'0 ca -� 3-co 3-cam cn -7 ��to Do�r►Erz7_9,r • I�S�-co 11 ?,_o �r 131-con 120 Main Sheet.01845 KAREN H.P.NEL-c0% is _ ._ cso8) 682-64MD;,�o. NoR� ANDOVER BUILDINGtet: �. - . - CONSERt ATIO\ o�vsco:c of HEALTH PLANNING g CONDIUN= DEVELOP! MNT == CH114NEY APPLICATION AND PERMIT DATE /-r/ / -� PERMIT LOCATION O N ER Is NA:1E sL'ILDER s NAPE `�'M��G- 1C�� e®� pi��C+�1� MASON I S NAME w/ :?iSCiI ' S ADDRESS M-2,TZ K_..!. Oi C:i i�11T i 1TERIOR CHI'. �dE EXTERIOR NLji1BER A:;D sIZE O :Ii=C :E..� OF HEART: �' ,• ^.fl.T Cr f • '•• _-? rBC^1rS Sa�.S Oi t.-,e Code al.- haT rules and rac .a"-rs�. CA - ST_ _ SIG..AOF MASON Yi,,-�� � CONTR. LIC. :^'liRE � ES,r. CONS TRU,CTIO:7 =RICE -1 j j j GRA."I'"E D I Z F - PE:L•1IT 1i- ROB- INS?ECTZD CT L REi^3Ri�S THIS P= T " fT -- BE DISPLAYED ON T' PRE:SISES I CERTIFICATE OF USE & OCCUPANCY Town -,Ql Orth Antic v ,t• tll Building Permit Number �� 9 Date A� THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS IN_ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE B SUCH OTHER REGULATIONS AS MAY APPLY. UILDING CODE AND � ra CERTIFICATE ISSUED TO D1401D ADDRESS W - CM - `mss Buil g Inspector ; � w $ a � ky , C 5 IAORTH . o o �0 6 . } dover No 4 579 oor d ver Mass. � la COCHICHEWICK ��• -'�` ADRATED BOARD OF HEALTH "Food/Kitchen Septic SystemPERMIT T ' �V BUILDING INSPECTOR ;1� THIS CERTIFIES THAT........................... ' ME. ,S't' ,5,'1.1....................................................... ,. oundation ;. has permission to erect. .... .., buildings on . ..........� '1 .....5..r.4........... Ro ! y to be occupied as. lt►�.tL .....�rin1�!1 . UJ �. . ..('...AR.. ..�A��A�w.l --................. Chimfn'e',`.t'y P P accepting P Y p ... pp .. Chimney provided that the person acce tin this erm' shall in ever res ect co form to the terms of the application on file in `� �inal this office, and to the provisions of the Codes and By-Laws relating to the Inspecti f 5'7z--9G 5." Buildings in the Town of North Andover. ��� �� � � REGULATED BY PA X114.8-S. B.C. PLUMB G SPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. G LG°✓"t-Q �:y PERMIT EXPIRES IN 6 MOI�,P FEE P DLOCI UNLESS CONS C ELEC AL RSPECT PERMIT FOR FRAME/BUILDING Rough I .. ........... .... ....... ........ . ... ... Ser-vice-------- DATE. 3 FEE PAID' LDIN IN CTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — 0.Vhf `��"�1 S � p es Do Not Re ove .r 09 No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE A't'IMEr NT = Burner - PLA q Q�V _ NNING �INAL CONSERVATION M i l �� \ Street No. SEWER/WATERoke Det. ?rGc� FINAL DRIVEWAY ENTRY PERMIT_-