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Miscellaneous - 45 SETTLERS RIDGE ROAD 4/30/2018
45 SETTLERS RIDGE ROAD ! 210/061.0-0105-0000.0 Date.A t NpRTM TOWN OF NORTH ANDOVER ° PERMIT FOR GAS INSTALLATION jSS�CNUSE e \ This certifies t . . . . . . . . . . . has permission for gas installation C Q4 . . . . . . . . . . . . in the buildings of �-:-: . . . . . S�. . . . . . . . . . . . . . . . . . . . at . . �7. . . �?r,S. . .ac�JQ- , N/orth�Andover, Mass. Fee;IG?. Lic. No.k5v.�. . . . GAS INSPECTOR Check# 8E06 f 9362 y NORTH <,�•� .�4,0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SS�cMUS� t• This certifies that .( � �1�---. �. lPS4' �i.r� _ �. . . . . . . . . . . . . has permission to perform plumbing in the buildings f . ! `�. . 0��� . . . . . . . . . . . at. . . . .��?Ott P I�?. . . . - . a�i�., North Andovef,, Mass. Fee.ft p. .Lic. No.A'*'? . � . . -. . . . PLUMBING INSPECTOR Check # _ 3� R MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIt TO PERt=ORM PLUMBING WORK L- f CITY , �t C1 C� �M DATE! 'J/y /)-I' I PERMIT#rt a JOBSITEADDRESS 1 '41j- Ski�' e�S �l d e—I OWNER'S NAME )&P 6-T'0 SS OWNERADDRESS( S 19� Irl TELT IFAXI I TYPE 011 OCCUPANCY TYPE COMMERCIAL EDUCATIONAL I RESIDENTIALJ>-'�, PRINT CLEARLY NEW.I •I RENOVATI¢9:1 kEPLACEMENT: PLANS SUBMITTED: YES I N01 I FIXTURES 1 FLOOR-' BSM 1 2 2 4 5 6 7 a 9 . 10' It 12 13 14 BATHTUB _...-j..... .._ ._ .!. .. .. . . ...... ...... . .. .._,. ..... ----- --...._i,. I;- CROSS CONNECTION:DEVICEDEDICATEDSPI=CIALINASTE-SYSTEbI f .. :...., _ ::: . _ __ `....:.... ..: .�' :... .._. .;.....,. .._.. . DEDICATED GASIOIUSAND SYSTEM DEOICATEO GREASE SYSTEM DEDICATED GRAY WATER SY6TEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN I _ FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK :I..... .. _. i i ! LAVATORY ROOF DRAIN SHOWER STALL $ERVICEIMOP SINK TOILET URINAL I._ ...-I...._ _.� WASHING MACHINE CONNECTION WATER HEATER ALL TYPES. ----- --., _ .- - - - ---------- ---- - -------- WATERPIPING INSURANCE COVERAGE: have a ctirrent.liabilit ihsinitce policy.or its sulistaptial equivalent which meets the tequirenients of MGL Ch.142. YE8>4-,NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE-BY CHECKING THE APPROPRIATE 80X BELOW LIABILITY INSURANCE POL(Cy K. OTHER TYPE OF INDEMNITY I GOND 1, I OWNER'S INSURANCE WAIVER:I ant aware that the licensee.rioes not have ihe•insurance coverage required by Cfiapteel V of the Ma a husetts General Laws,and thatalty sicJnatare on this Qertnit epplicatiQn�'+aives flus regltire(nertt. CHECK QNEONLY:. OWNERI ; AGENT-1 -1 - - SIGNATURE bF.OWNEkOk AGENT I hereby certify that ell or(fie details and irifonnallon I have 8bbinlitted of entered i4ardin 'this application 'e true and ac r e to the best or my knoerledye and that all plumbing work and Inslalfalions performed under the permit issued for this application Wil n ompliance e• t al Pertinent provision oilhd &1as$achusetls Stale'Plumbinc3 Code and Chapter 142 or Hie General Lays. PLUMBER'S NAME�.TV� c ILICENSE#I j 36?f SIG URE MP( ,1Pi CORPORATION( .111! 33 3 IPARTNERSHIPJ' !III' LLC 1' 19I I ADDRESSJ COMPANY NAME S— S i�f� S S I 1 cam. 1�sc CITY I4r,/ra-e' /V STATEI��/'C)- 'I ZIP cf I TELL �07V 1I,-77C`96�I S'? F FAX I I CELL 1 ij23(7 431 EMAIL I f I 2OUGH pIGUJI ]bJ�7G 7[t�TS`PFEDI C rON S. MoVi MR, COD � � dr ugn,any MNAL IN S1PEMO.1r7NOTIl;S Yes No 7 THIS APPLICATION=SERBS AS THE PER-nni T ❑ FEE::$ PEEt111IM >PILA14T 1�1.1dTOWIS , � p I - , ► F V 1 t� �`1t�Gfpi�titio'ajtuefi�tlt P,� c,'%c�lf�fiits�,fls ���i�iE+ltl;2ri�o�Xtttfitsr�ttrl.•��e�l�itfs f4.11 irsaigfoi,41lett �Tl[tslott;l('l�IQ�JrJrX �'`' 'ji+j�jt►,tx(rss�oi�tfrt �ir4krt:Ct`S��`QI1tj1Cli5�ttktltt��'t�sl,�i'sitct;��i(itlt}',;f t�liiCttt:Ysl�Otti tttttoy:sible�#'►•ic.;ti)tsli��uiu'l��eli� i tttiIieitttITtforitttiEiliit _ _p7etis .t?►(itf:lei?il'i 14itttie(t3ij31'ut�rt�tUi�liu�idont/rtifiridtlalj' 141011dk' . . ..- ... , . 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Shaiildypil ltt►tiu�i7tty' [teSl o»s rs :i4$iltatlte Intt 6c ifyl iu are:required to:ob61t 1n workcra f;uliip!,zti�,�tionpolicy;pleaseca11f31e`A�lialtineatlitt[lenumber�isfecibalots�.�eIf-itistliytt•cfllttpatites�lt�ulctenfertilcir � etFinsutgtice Wow numberolLtlienppropria(01160 City of To}til fllfictais Isle[tseb -sitl•et}iltEflaeofCiiat=it�sioti�leteatlttlirilitet�ieblEal�: �Ttabepatttilealthas�aroYiaecl�.,lizcpatth�Gottolir gC�Rr;aftrcTat'it tofyrofltri 1-11 octan th"vVetafthe Oftic1*Whivedigatioitshm to cold,.efyouregatlAbi�&.1,pplicallt, Plea s�faesurtoftllinihepentgill!}ce»srttHuberti'lticlltyill.be.itsed'osa:relerencaiprllTizt�InacitTition an:tyap)ic�tue 1-ltafmust strt»nitntitlfiplepen»lJiice»se hpplica[iolis`i»na)*git!0113+ealisteetlonly=sttUntiEoneff_rdat�ieiutlicatingculreatt blit'*Intoamatipn{ifneeess�ry�?ald.luc�ei�`doliSifaAcficiress"tileapplicatit'shot!Icl�vrite�f,�lClocaiiolis#u �6iyi1}'T A cgpy oftlle a[h'dat'it tliatLastieelt of�cialCysltutaped or ntalkect by ihe.cifyF o:foit�11i1aS�Ueprot idcst in the ` bliplieanYaspro Offhaeatralid Offiidmidsbti iile•forfr[ure-perch&oflieenses. liety.tif�idat'if must befilfe<t ouf a teh ` Y2='ir Vgierelt hottte iitt°ner orcif[zett i.ofifaiiilug_a licellse oi_perniit>iotrelatetl 1-o an}rbttslJleas orcoliimercial Yeritlaie F a(Ta9lice11s0 ar-`perraIII tto burn leaves etc)said persoIt.is XO'Fnguire d to col Iipletothls a ffid;ta ' . y_. _.... .__�>plaeq�CeofIrl}te�ti�atio:assn.�ou�il�li�ztOfitafi�3roi�iiiaitvatl�efort?olu�dd�rt'atEgiiallcts�tdlt�(R�'Ot -(li}io[ _ _.... ... .. _ .-�. _ .. ... _ -.. Oda seclo.nvtllesifafcto.givztisiicalt: ►saaj!t;; ,iestiolts,. 3 .tt.oA�t:)iat�a,iett►'sacldr�ss teleP1to11ea1tt1faalttaniTier, - e -Ttieo�ttttcta}4?�tTt1tii\ ssSz, it�sefi - IY3qal_iluent Of1gdttstii1jA1acznettts a 3 �i'>fice ol!••Iii}'+'sI;%�a� oli�. 60OVasllitip11 Street r M1Bosfoll,IitIA.0 I ;X 1 Tex. Gl7 x127-Q0D, VM A SAVE � -�ekls dl 26.os A'it`t-6i7,7271-77'49 1�'�}��.i�assgot'Itlia F a MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: /ljl. &,.,6 , MA. bate: 1 Z Permit# Building Location:_ �/ S�Tr�:°'��� /�'o(,%o Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement:-R Plans Submitted: Yes❑ No❑ FIXTURES - - - - - - Lu to - ui - - to z W IY ~ co cn _ �►' . F- 0=0 = W w UO W co Fes- O = W O z F- Z -j W Z to W o 0 H O W cn W m 0 F— W R" p 4 Fa.- > V W Z Vr W W z co W F- co Lu Z W -� Z mZ Lu Lu > Z F" 2:5 = > 0a0Z >Lx D li C 7 T O a W O Q SUB BSMT. BASEMENT 1 5T FLOOR 2o'-FLOOR WFLOOR 8 FLOOR Installing Company Name: S 1� � — `� Check One Only Certificate# J(,tiP C yj ��3� GG�� corporation Addresl/f 5- City/Town AJ State:J _ // Business Tel: C��j ax: [I Partnership Firm/Company Name of Licensed Plumber/Gas Fitt r: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YeNo❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance poljcOK–_ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner El Agent El By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Mpter 142 of the General Laws. Ty of License: By Plumber Title /� Z �s Fitter (gnat e o ' sed P tuber/Gas Fitter aster City1rown ❑Journeyman License Number: APPROVED OFFICE USE ONLY ❑ LP Installer r • 140 f The Commonwealth of Massachusetts Department of Indush ial Accidents Office ofInvestigations ..600 Washington Street Boston, MM 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ' Name(Business/organization/Individual): - - •-Address: -- - - –– — City/State/Zip; l, phone#: Are you an employer?Check the appropriate boa: 1•❑ I am a employer with 4. Type of project(required): ❑ 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 t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp,insurance. [No workers'comp.insurance 5. a are a corporation and its 9. ❑Building addition required.] officers have exercised their 10'❑Electrical repairs or additions 3.El.I am a homeowner doing all work right of exemption per MGL 11-El Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no insurance required.]t 12•❑Roof repairsPto ees. [No workers' • •• comp.insurance required] 13.❑Other "Asy apai;cen:tit checks bo=,t±l must also fill oat the section below E o inng+he _ _ 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 is providing workerscompensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal fine up to$1,500.00 and/or one-year imprisonmentminal penalties of a ,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. Ido hereby yy under thepal s ndpenalties ofperiury that the information provided above 's true and correct Signa 7 Date: Phone#: ` • Official use only. Da not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#: r 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-houseor 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 sub1contractor(s)name(s),addresses) and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with.no employees other than the members or partners,.are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be.advised that this affidavit maybe submitted.to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date-the affidavit. The affidavit should 1. bio for he r i G es nrequested, f 'o e artm'1t of bE.rct'+s1Fi've to Ehe Gl�}1 Gr tGC1 a tli��.ux &�up�aCB�.i;-u ..rr to p��r,:'a�t 1T_�GG�� IS 1' ztt� 11Q.the D�.p ,�• Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.. Please be sure to fill in the permit/license number which will be-used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be flied out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would•like to thank you in advance for your cooperation and should you have any questions, please do nbt-hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office ofInvestigatons 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-8.77-hSSAEE Fax#6.17-72.7-7749 Revised 5-26-115 urwur rn»c.c amdrTi a Date.... ........ 7 NORTI� TOWN OF NORTH ANDOVER ,�, f PERMIT FOR WIRING ,SSAC14USE� This certifies that .... �0 ............................. ............................. . has permission to perform ............... °?'................................... wiring in the building of...............S.>.i.i ..................................................... at...`.�... 5� 4�. PlbcEn ......U/. North Andover Fee. Lic.No..O& y............. . .�2 ELECTRICAL INSPECTOR/ Check # 10701 r. official Use only Commonwealth of Massachusetts - a Department of Fire Services PemutNo. /d 70 / BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ,All work to be performed in accordance with the Massachusetts Electrical CodeC),5 7 CMR 12.00 (PLEASE PRINT RV INK OR TYPE ALL INFORMATION) Date. City or Town of NORTH ANDOVER To the In ect ''of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? YesNo ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion ofthe ollowfn table m be waived b the Ins ector o Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o,o mergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIREALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and InitiatingDevices No.of Ranges No.of Air Cond. Tonsl No,of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained otals: _-...._...._ ._. .. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ other Connection No.of Dryers Heating Appliances KW Security Systems:*. No.of WaterNo.of Devices or Equivalent Si Heaters KW No.Si Ballasts No.ofData Wiring: Signs BalNo.of Devices orEquivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 p ' s an penalties ofperjary,that the information tlii ppli ion i true and con pjetnne. FIRM NAME: ti o LIC.NO.AF& Licensee: Signatu _ LIC.NO.: / gapplicable,e�jj`exec yt'in the license nu berlfne.) Bus.Tel.No.: �/7r9` �/� Address: /rte / pk (� �YJ f� L pr2 Alt.Tel.No.: 216-'? *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ a - T MEMiC.A�L��'•fE T RO, ✓�/.ui1V•+.i.ri1J�.R+.1�.M1.Lf 1J�®.Lv.� ' • .. '� • .. ~• 1 rL.✓.g0 V RJ�1.!41�JL I'...�J.iiO.4,� �• .. - • X'�sseds[ Waited—[ 1 Re-bspeevoA r6,q 'eR($-5OAQ) �nspectoxs'caznme�afs: ' + {xr ( nsp ectoxsyxgnatuxe•uoifzals} date Passed- +ailed--[ texnspecfiox�xeo�uixec ($50.00)- [ �tt5�ectaxS'comm�enfs; (Czispecfoz's', zgnatuze-xto' ials) date r9sed R GROM 1NgR)ZCTXON- . jailed- [ ) e�inspecfionxet�uixed($50.00) [ ] zs'ma m.ents: Chspectoxs'►igna*e-nokifials) Date DATE,CA f L ER D NA 10NAT,+G`31, Passed [ ) �`aiied-[ � �e-inspectionxegtrixed($50.0D) -j ] . X'nspecfbxs'eoanmep�fs: (�Tiaspectozs';9ignatuxe�nolnifials} bate )RRA ON-•OMR: 'assed--•[ ) pazXed• [ ]. enspectiottxe�ui�red($50.00) [ asp ectoxs'cozAoai.ents: (cusp ectoxs' zgn afore uo initials} Date ACCESSIBLE.AND.A.MUSPECTION O)`$50,00 is TO BY,C GED. . Y; The Commonwealth of Massachusetts Department of IndustriqlAccidints Office of Investigations k1i 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): X)eq F/ o CT-,a l c e /' Address:_ 6 Is ev City/State/Zip:/71,o Jy c?.4zz!7 a ©Z ��,( Phone#: Are you an employer?Check the appropriate box: Type of project(required): LM I am a employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions R right of exemption per MGL 11.❑Plumbing repairs or additions 3.El I am a homeowner doing all work myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 1311 Other *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 Lire doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. 7—aAV('/,tee Policy#or Self-ins.Lic.#: Expiration Date: _ Job Site Address )P/•c' S /�! �lr ['f . Ci /State/Zi P � tY p ,& 12 2 CI4 tiC?h Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for' ance coverage verification. I do hereby ert u the sins an enaldes o erjury that the information provided above is true and correct. Simature: Date: Phone#: d p� 63 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of f insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the y 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 co6peration and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Wasbington Street Boston}MA 02111 Tel,#617-72.7-4900 oxt 406 or 1-877,MASS"A.FB Revised 5-26-05 Faze#617-727-7749 wwwanass.govfdia 1 z 8 Date.,-'0 of NpRT'+ TOWN OF NORTH ANDOVER 0 y a cA PERMIT FOR MECHANICAL INSTALLATION s o9 ._.,w • �O+aro•�� 4h SSACNUSEt This certifies that �� r :? . �. ..: : : �J): :r has permission for mechanical installation in the buildings of . . . . . . . . . . . . . . . . . . . . . . . r F North Andover, Mass. ,:�.:-. . . Lic. No.:-)`>col . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee..... GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer —T ���-�--cam-- ��.1 - Commonwealth of Massachusetts Sheet Metal Permit Date: 3` ✓� Permit# Estimated Job Cost: $ Permit Fee: $ �� Plans Submitted: YES NO I1 Plans Reviewed: YES NO Business License# Applicant License# 7 `JF'6 �G� 7 Business Information: Property Owner/Job Location Information: Name: �/Lf� .�C , �� Name: Street: AgilM Street: �� ��T r��s' 24A5 S City/Town: kU/" City/Town:&A/o` ' . 6&292_ Telephone: ``'g,7, g 3VZ-S 39 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO V"*' Staff Initial J-1 /M-1-unrestricted license J-2/M-2-restricted to dwellin 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC 00 Metal Watershed Roofing Kitchen Exhaust System 1/ Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: . 0���6l P- C6G �/� INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G:L.Ch.112 Yes❑ No❑ If you have checked Yes,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 112 of the Massachusetts General Laws,ind that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent s' 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 sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and ChapterA 12 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License:. By ❑Master Title ❑Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number. Fee$ Check at www.mass.govldpl Inspector Signature of Permit Approval COMMONWEALTH OF MASSACHUSETTS . MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO` MARK. S COMEAU 23 SYCAMORE RD METHUEN MA 01844=7142 < 556T 03/28/14 129220 -. PERMIT NO. ` ' v APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP K40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE IBOOK 'PAGE ZONA E SUB DIV. LOT NO. 2 2 Il JTC� b 1 .0 �.r C.K LOCATION C &,TT) g f !� PURPOSE OF BUILDING e ,y\ OWNER'S NAME J t I G.L IH L&UH De NO. OF STORIES z J SIZE OWNER'S ADDRESS BASEMENT OR SLAB Y 6 _ ARCHITECT'S NAME "9—A gq% )1 ! .. IR , SIZE OF FLOOR TIMBERS IST � y 1\ 2ND 7 3RD BUILDER'S NAME � A& �L�J V�, �1� ` SPAN it. Jx - C—..fl/—V / DISTANCE TO NEAREST BUILDING F.i / DIMENSIO�N�S1 OF SILLS DISTANCE FROM STREET ` POSTS��7 --. --�_� & Vz- S/G L&Gy DISTANCE FROM LOT LINES-SIDES � , REAR/X, GIRDER$// AREA OF LOT �J�S Z FRONTAG5E I y 7/ HEIGHT OF FOUNDATION(�`/ /C (V THICKNESS IS BUILDING NEW CJ ` t\ —z 4&71 SIZE OF FOOTING 1G�� X d'+ IS BUILDING ADDITION /�� MATERIAL OF CHIMNEY pp,! KL igtd V IS BUILDING ALTERATION & 1b IS BUILDING ON SOLID OR FILLED LAND Se) (/2) WILL BUILDING CONFORM TO REQUIREMENTS OF CODE y IS BUILDING CONNECTED TO TOWN WATER 1.1 rT BOARD OF APPEALS ACTION. IF ANY /\ / IS BUILDING CONNECTED TO TOWN SEWER v IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST /Z®,":V,06SEE BOTH SIDES EST. BLDG. COST ( 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 y f SEPTIC PERMIT NO. /�J 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 FIL 6r 2-f( / BUILDING INSPRCTOR SIGNATURE OF OWNER O ORIZED AGEN F E E OWNER TEL.N �� 2" ✓ � PERMIT GRANTED CONTR.TEL.J 19 CONTR.LIC.>Yla I / C> H.I.C.11 /e7 97j! Mm I r BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE a 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 _ 1/1 1/2 1/1 FIN. ATTIC AREA _ NO B M'T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDIV D _ ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORPOOR _ ADEQUATE I NONE 5 ROOF 11 10 PLUMBING GABLE HIP BATH Q FIX.) GAMBRELj_d MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES a� TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FUR_N. TIMBER MS.I COLS. STEAM STEEL BM OLS. HOT W'T'R OR VAPOR WOOD RAFTER _ AIR CONDITIONING RADIANT H'T'G �+ UNIT HEATERSt� .. 7 NO. OF ROOMS GAS jef OIL I'M'T 2nd ELECTRICst.t. ltt �I 3rd I NO HEATING , `_ I. ` ? wea Location No. .3 c;� 57- DateOf NORTH TOWN OF NORTH ANDOVER O A • ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ a qd r s►cMus Foundation Permit Fee $ L Other Permit Fee $ TOTAL $ Check # c> 3 i Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: X CCS 3 SIGNATURE: Building Commissioner/125j&tor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �d9 _ 6 fIU Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: �2 Zonina Distrid Proposed Use Lot Areas Fromm e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided ReqWred Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ t1-1Licensed Cornstructi n Super : � 4619,0O License Number C� mn ;n;#e > A Ad t7 L3,9 74 ExpiratioDate _ Zic e Telep one r M< 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Com y arae �J M dove RegistrationN tuber rM _ A dres r Expiration Date Si ature Tele hone G) SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi26armit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Descrit' f Proposed Work check all applicable) New Construction IM Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 3 D,e e`,4 d,4V-e'47- /D ' //1 ' SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 020 2 Multiplier 2 Electrical (b) Estimated Total Cost of 0 O 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 CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ���e-5 e as Owner/ thonzed Agen subject property T Hereby h ze to act on My alf n 11 matters relati to au ed by this building permit application. Z Sin ire o wner Date SE TION 7b OWNER/AUTHORIZED AGENT DECLARATION h as O-vvner/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 Prin am Si a e of Owner ent Date + NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DINTNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE y FORM U - LOT RELEASE FORM to 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 . _ PHONE A6, 7e-1=1 LOCATION: Assessor's Map Number / PARCEL O`�— SUBDIVISION_ LOT(S) STREET ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECqIqMENDAT1ONS,,9F TOWN AGENTS: CONSERVATION ADMIN RATOR DATE APPROVED I DATE REJECTED COMMENTS j ` § ` Tc4515e, ?f all TOWN PLANNER DATE APPROVED _ DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED C� W� DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT 9 FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm A 8 LO T Z ' ZZj ssz SF 'mow ti x, ODZ Sly 'R SFO *qs N � •N go ,7 R 8z 677-Z- - S CT7-L ek S !2/0(fyL_ I HSRSBY cum" ro = mu INSl1RoR AND PL 0 T PLAN TO M MW nUr rHS DISLUMG IS LOCAM ON IN MR Lor AS SROIN AND rMT IT DOSS CONFORM lllrH rHa "~ of mo, 09N,00we2 Somma RaGULA17ONS Non TN ANGbvC72 rfAss. REGARDDVG SarRAMM MOM SrRaarS & Lor LINES.' I FURMR =RTIFr WAr THIS DIRLU NG IS NOT DRAWW FOR LOCArSD 1N THS FRDSRAL FLOOD HASARD AMU AS SHOW ON FRMA C0JWXIrr PANEL � zscxa qe ,t3�liqh/ ,� N��7i2Y Gloss sTr, sraP L.S. tura i "= yo ' J191^lJ Iq99 N- THIS P 9 ltiYor'PURAOsas - Nor FOR NI J[l�RRIJGlCK 1�NGJ'l�RING S1�RI':CJ`S BOUNDARY rl ?'' BoummRr I romrION ee PARK srRs rA"AF FROM aCORDS. r1-uio 3 11ARD01W.R. J T UCHUSRrrS 01810 .w f 1NV � l j 219.00 228 _ 1 �2 #163 -RAP # 2 H. IDG _ 7+ - C8-02 - - - - r _ QO R. O D 8+00 S. H. ES - 6+00 w I X162 W _ OMH�O 1 p H S 00 % PROP F/ N1 12"1 RIP-RAP/#1 IP-RAP \ - - -11Xg #1 0 #174 - r 1 PRO ` / TV 18 ROCP \/NV = / \218..50 �\ J \� 175 LOT � —1 \ LOT .2' \c fi VNERGY LOT -3- RAP ' 1 \ . -\Q _ _ o A-TERV VEGE TA TES ' LOT 216 \a \t'#160. ( lP-fNP SYaL� 176 �_- - LOTQn '-RUC TURF_ i t � 200.0 203. 1 (24') \ \ / The Commonwealth of Massachusetts Department of Industrial Accidents Office ofinwes>}igations j Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Milli Will 111 Name: Location: C-itv Phone am a homeowner performing all work myself. ' 01 am a_sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. coo-pany name, Address C&: Phone Inauta- Co. _ Pollcv# A_[dre_ss /� C IY oldl_ Phony#-ow, 7e _.. Failure to secure coverage as requfrect urVUW motion 25A or MOL 1,552 can lwd.to the and/or one years'imprisonment as well as dvU d aM&ct naldes)away agal to$1.50D. penalties in the.torrrr at a STOP INC)12K O�and a nne aF(3100 OOj a day against me. 1 understand that a copy of this statement may be forwarded to the Office of kwestigaftm of the DIA for coverage verNkatim. I do herby certify and pains arrd penaiies of perjury the attar pn5vided above is true arNi caned Signature Date O Z Print name Phone# Z Official use only do not write in this area to be completed by city or town official' Q Building Dept Q.Check if immed ale response is required Building Dept Q Licensing Board Q �Qlectr»an's office person: Phone# Q Health Department Q Other ',St WOftKP.Ay's cofMpl fiSttT10 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: 14/i (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector JAMES C. ERB CONSTRUCTION 8 Baldwin Street ic North Andover, NIA 01845 978-685-2022 Fox 978-685-3516 CONTRACT Brian & Meg Gross June 30,2002 45 Settler's Ridge Road North Andover,MA 01845 978-557-5423 Provide Design, Drawings & Permits Construct 10'x 12' addition to existing 10'x 16' deck,Enclose 10'x 26' deck will new walls (211x 6"w/R-19 Insulation) and shed roof(2"x 10"w/R 30 Insulation), Install new Anderson Casement windows as follows; F1 c,n +2 �e-30 2 C24 with Safety Glass,2 CW24 with Safety Glass, 1 CW_255 with Safety Glass (, t� 3 CW255 ��.9 �>oe T,m 1''i/IV,,, W#-X F � wood �- Z 2v��s `�� ) I Install new 218% 6'8" half lite rear door, Install new 5'0"x 6'8" French door at existing windows at dining room area to new 3 season porch. Install 220 circuit for Spa,2 receptacles,2 ceiling fans and 1 outside light Install new ceramic tile flooring. v,�A-4( S/PJ�o T 1- Z'' - V ao2 O t-'O'r t�) Install cedar area Spa area with Shelve Install Green board tape & finish on ceiling and walls (Smooth finish)& Painting Install 3 fixed Velex Skylights (22%46") Install 4 Recessed lights over Spa with Dimmer(4" Eye Ball) Ceramic tile allowance$ 3.10 a square foot Install Basement window Anderson Tilt(rwR8.90) Provide Snap in Anderson Grills Ceiling fans provided by owners ,1 ���� TOTAL $28,502.80 �J\STlfil( 7"art S" �Ve-T )0 �X15�J✓Jy Jt Se�-rrrl�SS �'✓�CrC /f'��rt y �effvL Deposit $ 8,000.00 1 S' Payment Start $ 700.00 2nd Payment Complete Roof $ 7,080.00 3rd Payment Complete Siding & Green Board Installation $ 3,000.00 Final Payment $ 3,422.80 nr Date Meg Gross Date / DZ mes C. Erb Date �l�e t;cmrrinrur�z/fh t�� :`�{c._uu•/auxtf. i BOARD OF SUILDI"REGULATIONS License. CONSTRUCTION SUPkRV.1S0R Number: CS 060825 _ t Birthdate: 10/1W1959 Expires: 14119/2002 Tr.no: 11841 Restricted To: 00 JAMES C ERB 8 BALDMN ST NORTH ANDOVER, MA 01845 Administrator Board of Building Regulations and Standards r HOME IMPROVEMENT CONTRACTOR " Registration: 127752 I Expiration: 12/20102 ' i Type: Individual JAMES C.ARB JAMES ERB 8 BALDWIN ST NORTH ANDOVER,MA 01845 Administrator i I I � � I i i I j i I ' I T I iell i. • 1 LI 1 p 9 - frOtO 6-9A 67 5 vo I 'tel j i T i i I I ' 1 I I � t jj -- ---- _ - 1 – 1 -- -- — --- ., .moi_ aFw ! ! I L - c � _ /�e�Ov✓ c�0�s�' 4 Alf.�`�� i i Ve)i 7 if U je ) ,A UU U(a NOiW Ledl : 14-6 Q} wr>od Svb - `;="loon , vtc� � ��7��e � ro 3 SeA50A) Po ec-�,y I ev O'l 60 0 :)m S,dF, ll t - ti ------------ -- - I I , i I _ - -41 - - -- '-- I _ I ' I 1 , I iI I I I , I I I , i .. s , I - 1 - i E ToVM of And No. 3 ,14000 C% z - j /a -/L • o 0�A COCH,C dower, Mass., DRATED PPa��S S H � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... ��N.....�... t... ............2 .................... Foundation has permission to erect.J.0...........L4............. buildings on 4 � �'�rs.� � a Rough ...................................................................... .............,... to be occupied as �� 6.. 'e S 1 •A� N�11 e N4 i�a I O�� a`� 1 N+0 Chimney p' ....I.... ............................................................................. 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 Constructi%sop^ of Buildings in the Town of North Andover. � ' ' S O '14004000 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough J .. .......................... ..................... ........................ Service BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. tfOR T Town of Andover No. � � LAKE over, Mass., 19 ' o - -C OCMICHEWICK .9 4O'9q E e S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......................................... .....A.R..A........ ..........0.6.0.►.....C..�. ......... Foundation has permission to erect....................I.................. buildings on .......IS.......... TT ........ Rough tobe occupied as.............................................:5...1. .J..E............ic.w,.'H.l......�.............................................. Chimney provided that the person accepting this permit shall in every respect conform to the ternfs 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST 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 ou h x No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. FORM U - VERIFICATIOiN 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: cue r , Phone LOCATION: Assessor's Map Number / Parcel S— Z. Subdivision �ir Lot(s) Street (-r 6l/ St. Number ************************Official Use Only************************ RECO DATION OF , A S: Date Approved Conservation Administrator Date Rejected Comments L" Date Approved'fr own Planne Date Rejected Comments Date Approved Food In ector-Health Date Rejected Date Approved y� 11Se c Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department (,(�, 0 a�7e'CR1w 01nf4C-1T k 5 9 Received by Building Inspector Date r TTLFkS RI1>GE- AAD, L-I�T Z. PRTE FLAN /74m-e ' 0 = 4d' D hTE- La/Z4/-17 Tara Leigh Development Corp. 185 Hickory Hill Rd. N. Andover, MA 01845 ' ET S 6foo , 62 i � #174 N' — 24 -N N �,. -A z pRo?asaD-twJ V 2LU1JG CI Vq • 1 U� b L — FDT I�c�lA2G �Z De�iN 'G 'SSZ $� / CO l �1J 1 OA0 � 2 ,�'JS bl 9, U - l CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MA. X, SCALE:1"='40' DATE: 7/7/97 Scott L. Giles R.P.L.S. Frank S. Giles 50 Deer Meadow'Road North Andover, Mass. 50.00 Q N O O W �I LOT 1 LOT 2 M 22,552 S.F.4. t LOT 3 5 r? 1 _�o\.�cor� 4� S� SN Of I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE sco THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE N0 WITH THE ZONING DETERMINATION OF ZONINGTER�° �� BY LAWS OF CONFORMITY OR NON-CONFORMITY LAMo`' NORTH ANDOVER, MA. WHEN CONSTRUCTED. WHEN BUILT 7 / 7 / 97 CERTIFICATE OF USE & OCCUPANCY <C Town of North Andover i Building Permit Number `�1 Date j THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. b CERTIFICATE ISSUED TO � f p 40 ADDRESS .,G JACHUS A , Building Inspector i T40 Town of dover No. dove' r, Mass., 06- lei-:z 19 ® 1 LAKE AO-COC ICHE ICK RATED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THISCERTIFIES THAT.......................................... ................ .. .......................... ............ .................. ...................... Foundation has permission to erect....................................... buildings on ........ *.X............. ......!.......'.............r tobe occupied as....................... . ............... ...... .....................I.................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of YFhn Buildings in the Town of North Andover. PLUMB SPECTOR '7 0 VIOLATION of the Zoning or Building Regulations Voids this Permit. 1> n PERMIT EXPIRES IN 6 MONTHS ELECTRICAL WS E R UNLESS CONSTRUCTION STARTS R _:o:u�> 00'/' ............. .............. ..................... Service BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPeCTdR_ Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIDEPARTMENT Burner Street No. S=ke Det. �"&w4p<0 i w Y d Ilk Ofece Use Only r G,4r Ll mmunwrafth If gusar4mitt5 Permit No._//0V Bj:V tmzrrt t7f Vublit 26aftlg Occupancy S Fee Checked k�V_r BOARD OF FIRE PREVENTION REGULATIONS 527 CAR 11:00 3190 peeve blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Cade, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) r.,(__2 Owner or Tenant " '`� C(zd U(--'ole,"•t- �^ Owner's Address t C-4-4—o-_,i k4u —,ik— Is this permit in conjunction with a building permit: Yes ✓ r_ (Check Appropriate Box) Purccse of Suildina 11 is)t,mac—� ✓Cwt L Utility Autrortzation Na. o6 Existing Service Amos _J Vcits Overread Unagrnd �. , No. of Meters New Service �U Amps 1 Z`� Volts Cverneac _ UncSrna r✓/No. of Meters Numcer of Feecers and Amcacity Lccaacn and Nature of Prccosec Elec:,:cal 1.11crx �_UUCDt-�= �— No. at L:gn;trig Outletsiotat No. cl Hot '.cs i No, of :ranstormers A KL i ` No. of L;gnting FixturesZSi i Swimming ?aoi g noe_ grnc. _ Generators KVA C/ I t No. of Emergency Ugnting No. of Recectac:e Outlets b No. of Oil Eurners Sarery, Units i No. at Swimn Outlets No. v Gas Eurners l I FIRE ALARMS No. at Zones t No. at Ranges I No. of Air Ccnc. total Na. of ons Initiating ng ono Cavic Devices No. of Oisoosaia ( I Na.w Heat Total Totai ?urncs Tons KW No. ct Sounaing Devices No. at Sant Containea No. of Otsnwasners ScacerArea Hearing K1,4/ Detotec::onrSounarng Devices INo. at Dryers I Hea:;ng Cevices KW Lccar Municioar_ Cannec•;on _Other No. or No. or Low Vaitage No. of Water Heaters )(iPJ i Signs Sailas;s Wirng • No. :•ivcro Massage TuOs I No. of Motcrs Totai HP I • OTHER. INSURANCE CCVERAGE: ?ursuant :o trio requirements w r.tassaC%Sers ;enerat Laws I have a current Liaouity Insurance Poucy inclucing Czm,,:eteq�ceraticns C;,verage or :is suavannal ecuivatent. YES '�_NO = I nave suamtrtea vatic goof at same to trio Cffice. YES Z---_14O = It ycu nave cnecxec `!ES, aiease inotcate ;no type of coverage cy checKing the aopra ace oox. INSURANCE -_t/3CNO = OTHER = tP!ease Scec:fy) 0o (Expiration Dater Estimatec Vatue at E!ec:ncai 'Nora 5 oy0- Wl`v s worx :o Start Inscec:ton Oata Aacues:ac: Rouge Finan Signec unser : e Penaities of perjury: FIRM NAME �✓trl71Z [�.�G-i���c �L�S UC. NO. �t2 S� L cense• !V�\�1��E�t;F �/� t t SiS-at_reAA-A LIC. NO. f.Z7 f(D Sus. :ei. Na. � t52��J4 � 1 � b � air. :et. ^ta.Acoress :f 5 (I > � .✓� O� — OWNER'S INSURANCE WAIVER: I am aware that trio ::censee saes not nave ine insurance coverage or its suostantiat equivalent as re- cuireo oy Massachusetts Ganerai Laws. ana :hat my signature on :n:s cermit aopntcation waives this repwrement. Owner Agent v tP!easo cnocx ones -eteonone No. PEtitMIT FEE $ 0-9 iSignature or Owner at Agents s-65o5 ~y Date... TO i •� 1104 HORTI{ TOWN OF NORTH ANDOVER 0 ' PERMIT FOR WIRING ,SSACMUSE� This certifies that .. .... ........................................ has permission to perform-,—, . wiring in the buil ' g of.�4'5........... ......... ....................... at .... . ...... . ............................................ ,North Andover,Mass. Fee �Y/�. ....... Lic.No ........................................... ELECTRICAL INSPECTOR 08/48/97'11:55 249.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer • NORTH ANDOVER, Maes, ()ale Bugding Pemdt Louilon _ S .S erT��.tr ��dg C J2Lf G.o'T o2 Owner's «� Name zd?e,6 New [rRenovallon ❑ Replacement ❑ Plane Submitted: Yea❑ . No ❑ FIXTURES w w : W » r W •� ow 0 t at } w .1 w w M a w 1' u ss It 4 • 16 ! s w M� u at Os s w r t• < A ` • • • ; 6 4 Itr M tt �' i : •1 w .1 .r 0 Q' .r .. ►- u � g s at •� tut—ttYT. tAttMtMT 1tT FLOOR 1 INO FLOOR ol 880 FLOOR 4TH FLOOR ITN FLOOR tTM FLOOR, TTN FLOOR - IT" FLOOR - - Installing Company Name Q 1e Check one: CettMicate - �• B �" 7-i�� Q tea. Address d C�ti G�C Aj ❑Partner ahi i p p ❑Firm/Co. Business Tete hone - 0 3.-3�2 7 �Q-.Name of Ucensed Plumber /U2 INSURANCE COVERAGE: 1 have a current IlablRy Insurance policy or Ns substantial equMleM. tc Ye No N you have checked YW, please Indicate the bo ❑ - . . .. type coverage by checking the appropriate box: ' y Insurance pottcy_®/ Other type od indemnly ❑ Bond Q OWNER'S INSURANCE WAIVER: I im awraro that the licenseedoes not have the lnau�inca.coveripsrequlred by ` Chapter 142 0l the Mass. General laws, and that my alpruture on this permit applicallomwahras-"4s _.. tsqulrattsMt.-- _.._ Check one: ..-_.__.... . ___ a Ura of Ownst Or omm.a an Owner (3� ��,❑•.,.,.,.�..T�,.,,.,.,,�,._�. 1 hNeby certify that AN of the datalta and Intormalbn I have suNrAted for entwedi in above Inowladpe and that an phrmbtnq work and IndrJrat{ona acebd.aonsatato{bt.b,al.ot:�py_ parllnanf pf"slone of the Mau"huf4 t Slats Plumbing «�a a I Wa� �0f1 be.in �rt+pAana vrith aA bkq(bola and Chapter 112 Oanerat l�wa. ZLI TRIO ftn&tur bar Mflown Uc.nse Number /S�7191? bi f Plumbing M'Pf10VfD(OFFICE USE ONLY) Type o 0 Lken se. Maslar [[{� Journeyman, ❑ i IC Date. y �1.�. . c3413 NORTH TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING I i w y ,SSACMUS61, Et This certifies that .�3r—�� `' S P Pot has permission to perform . . . y4c� ��. 4. . . . . . . . , plumbing in the buildings of . . !4 . ��, e . . . . . . . . . . . . . . at. 57—r,. f{.�r/A . R t C15 . , , orth Andover, Mass. Lic. No../Zrf-�. . . . . . . LUMBINGINSPEC 0 t po PAID WHITE: Appli 0108197 RY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) q NORTH ANDOVER Mass. Date 4uilding Location !�� � Permit # �26-d I-- *� L o,__ a Owners Name '7'we t V/, • New Renovation D Replacement Plans Submitted D FIXTUR-S N al v x IX ' N cc N a .o � N W p} LUO V 0� f• = N O W N 4C a z = W O F. W d m H N W w O Q 0 h y t tu W 07 W z Q z a cc W Q fO' Q h Z t7 t. Z h Z-e ccH w W Ca d us ? k h W l F W a ,u � a W z Q a: 4 a x o c� u. a c7 v y Q no. SUR-SSTAT. t BASEMEMT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name 5-eVCU _ 10L 91c V- Y-eyiy (� Corp. Address /02. Partner. .-V,2 Lt A.,/ 6 3,PJ'7 Firm/Co. Business Telephone: 79a Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q 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 coverages. I� Signature of owner/agent of property Owner El Agent F7 I hereby certify that ad 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 petfomud under Permit itteed fez this application wW-be in compliance with all pertinent provisions of the Massachusetts State Cas Code and Chapter 142 of the Cental Laws. By TYPE LICENSE: A40td, Plumber Title Gasfitter Signature of Licensed City/Town Master P�b r� asfitter Journeyman APPROVED (OFFICE use ONLY) License IJtultber Date.f.�. r. .I.7 ... ....A 0 NORTH TOWN OF NORTH ANDOVER 0 • `p PERMIT FOR GAS INSTALLATION CU . � CU SS�CHUSEt cc O � This certifies that . .,17�,1 .,�.4.� :r. 1 . .!`t. . . . . . . � has permission for gas installation . . A in the buildings of .. .. . . . . . . . . . . . . . . . . . . . . . . . . . at S' .l.' North Andover, Mass. Fee. .-?.q,.7. . Lic. No.. . . . . . . AS INSPECTOR WHITE:Applicant CANARY: Building D pt. PINK:Treasurer " Date..1... .271 77:;�. f NCRT 1 Q?°•_�`".;•�."ao� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,"SA CMUSE� This certifies that � T C c)ti ... ......r .. ................................................. WUv� has perngission to perform ........................ ................................................... wiring in the building of at......5"',�........ ort d er,Mass. :......... Lic.No ... .... ................... ELECTRICAL INSPECTOR Check # 43j0 THE COMN10N4VEAL710 'MASSACHUSETTSOfficeUS oai�— DEPARTA1EVT0FPUBIICS4FL7Y permit No. BOARD OFMEPREVE M0NRW UL4H0NS 527 CM1100 Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1 ,27-c-3 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) / ' 4Z Owner or Tenant �/�,,� 177 Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) . Purpose of Building 45 i-14 !eyC/ AJd x.74-0 / Utility Authorization No. Existing Service 26*J Ampsav /,. Volts Overhead Underground ,>7 No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work (V1 R/N S Su v EVr711 nc r7Cd7-S .c Z 7S iE TUR No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground round No.of Recept'cle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets Jw No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water HWaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP 1 5�;'3^li C' t'C•'rr l OTHER• lir>s<aa<IoeQWrdr-Pti UtotthelagritanU&ofMXM&IS ttsCtMZlLaM IhawaamtLiability> roePoky MJndW CommgzortssttlMltialegttivabt NO Ihawstlbrn*dv3hdp100f0fSarne1o1heOff=YES r7p IfycuhavedrdodYES,plea nicatethetypeofmwraWby dx�dmIgthe-- box INSURANCE BOND O�IE[Z y) FxlmatioriDa� F�rra�dValteof]]aemcaiWotk$ WotktoSmtt /':�y'D3 h>,spectic>nDateRegt>es�d Rain (TJ/�' Final G.l��i SignedunderMiePb>al rsofpaw FIRMNAME MAJ/2 �[r'7�f C Licenrel�Io. /yld 3 S Lich �fl f Z Sigr><lhue ✓►t"CG (,2 Iice WNO Bt>sirmTeL N0. fvl 7-(o Y' 7��k 4ckftL'�c f-'��11O1�1 ST �+^l1C��LI,���p �V1 L�`�l�(� AIL Tel.No 1 S D dl 4L DWNF1Z'SINSURANCEWAIVER;Iamawarethat&LicemdoesnothavetheitLnu =0C)Mtageorits&ftmtialetuuvalaxastegttitedbyMassac1xwMGeneralLam tnd thatmysignatLmon thispemvt application waives ihistegtla�rlalt :Please check one) Owner Agent ��� Cl l Telephone No. PERMIT FEE Signature ot Uwner or Agent