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Miscellaneous - 461 SUMMER STREET 4/30/2018
461 SUMMER STREET 210/107.A-0085-0000.0 Date............. .. ..................... .... 40R'rp# TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Hu This certifies that'.....!I.................................................... . ... ..................... Vu P��� has permission for gas installation ................... in the bu-i!dings of..............6,A..A1Pu-%f......................................................... ......... .. ......... at.......` W....... ..... ...................................... North Andover, Mass. Fee....................... Lic. No. .......................... ...... . ........................................................ GASINSPECMR Check# 61 9704 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: b MA. DATE: fab Zv( PERMIT# JOBSITE ADDRESS: 140t Sly VMK Me Sfred OWNER'S NAME: Rj GOWNER ADDRESS: �1�Q I SUM Y1 e/ 1 Y C CJ) TEL:"17 0 7�q '��7 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL F EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW-.)q RENOVATION:.❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCESZ FLOOR-- Bsmt 1 2 31 1 4 5 1 6 7 8 9 10 11 12 13 14. BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER r WATER HEATER _ t w INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalenta which meets the requirements of MGL.Ch.142 YES [9'N0 ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee Joes not have the insurance coverage required by Chapter 142 of the -' Massachusetts General Laws,and that my signature on this pi=it application waives this requirement. 1 -]CHECK ONE ONLY: OWNER AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best 'f my Knowledge and that all plumbing work and installations performed nder the permit issued for this application will be in compliance all Pktinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERIGASFITTER NAME:M a J'Y, I CO LICENSE# 36S5 71 SIGNAT RE COMPANY NAME: ADDRESS: t CITY: c -e STATE. A ZIP: FAX: TEL:$ '936-Zi 9 3 CELL: 936- Z/ S 13 EMAIL: 1 MASTER(JOURNEYMAN❑ LP INSTALLER❑ CORPORATION PARTNERSHIP❑# LLC❑# .. �t. Li,, r . .a. �j >1�1, 1 SS�� - _ - ��� Department'of Industrial Accidents Off'ice of Investigations 1 Congr�ss Street,Suite 100 Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): A J !r C C> y-b.T I Address: S i— i City/State/Zip: '( -f_ i Phone#: ��97) 3 Are you an employer?Check the appropriate box: Type of project(required): 1.[?II am a employer with .3 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 par4ner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P t3' a 9. ❑ Building addition [No workers' comp.insurance comp' insurance' 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right!of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Aof/ llT&Cl i I Policy#or Self-ins. Lic.#: (J .� ��'L) 7 d Expiration Date: Job Site Address: `AO Sum(hed leell�j City/State/Zip: M610% An(in l/PJI 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert& under the airs and genalfies 2f eEg'�t ry that thein ormation provided above is true and correct. Siafore: Date . �---`_.. -- I Phone#: �� 9 7 . ' 9-3 6— Z,, 3 Official use only. Do not write in this area,to be completed by city or town official I City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.CiJTrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other !� Contact Person: I Phone#: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY]AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Bernadette M. Danis, I',CPCU N ME: EA Stevens Company, Inc. PHONE (781322_2324 1 FAx 389 Main St. A/C No:(781)397-7672 P. 0. Box 188 i -ADDR6S:bernadetted@eastevensins.com bernadetted@eastevensins.com MaldenINSURERS AFFORDING COVERAGE NAIL# MA 02148 INSURER A-Mart ford Fire Insurance Company INSURED INSURER B:Safet 19682 , MAGNIFICO BROTHERS PLUMBING Ins 9454 HEATING & GAS FITTING LLC INSURER C:Tw1A Cit Fire 9459 31 FOREST STREET INSURER D MIDDLETONINSURER E: MA 01949 INSURER F: COVERAGES CERTIFICATE NUMBER34aster 2014-15 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE IAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE -- INSR WVD POLICY NUMBER MM/DD EFF POLI P LIMITS GENERAL LIABILITY i 1 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY — A CLAIMS-MADE 50 OCCUR 85BAUQ5370 i /24/2014 /24/2015 PREMISES(Ea occurrence) S 300,000 MED EXP(Any one person) $ 10,000 I PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE Is 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1 X POLICY PRO PRODUCTS-COMP/OP AGG S 2,000,000 LOC AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT accident) $_ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 053635 AUTOS AUTOS /24/2014 /24/2015 BODILY INJURY(Per accident) $ X HIRED AUTOS X AUTOSWNED j peOr acc�de LO GE $ X UMBRELLA LIAR $ OCCUR EXCESS LIAB EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTIONS 10,000 OBSBAUQ5370 /24/2014 /24/2015 C WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITYX WC STATU- OT}I_ ANY PROPRIETORIPARTNERIEXECUTIVE Y/N jER OFFICER/MEMBER EXCLUDED? F—] NIA E.L.EACH ACCIDENT $ 5.500 000 (Mandatory in NH) 8WECRJ9050 /24/2014 /24/2015 If yes,describe under I E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500 000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additionali Remarks Schedule,If more spare Is required) i i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hartford Fire Insurance Company ACCORDANCE WITH THE POLICY PROVISIONS. One Hartford Plaza Hartford, CT 06155 AUTHORIZED REPRESENTATIVE Thomas Cares, Jr/ML ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN.Rf195 r?mnnm m Tho AP11nn name and If nn are r—laf A—rtrc..f Armon y,Yq. .' COMMONWE A TH OF MASSACHUSETTS ARD PLUMBERS AND GASF ITTERSrAk: i ISSUES THE FOLLOWING LICENSE REGISTERED AS A PLUMBING CORP t a4 MARK MAGN I F I CO i. F �4 y" t�. 14AGNIFICO BROS PLBBHGT,GAS F1TTI 31 FOREST ST W y\ ww � r My�1 p P MIDOLET ON MA 01949-201+3 3266 05/01/16 20466b f w . COMMONWEALTH OF MASS _ f "' ACHUS�TT S �.�s-L•�_?�..-_ - .a+:_......3' x,r...L`.?._..�tiy.4 k z« f«i.- T 80ARD OF b_ PLUMBERS AND GASFITT'ERSII ' n f ISSUES THE FOLLOWING °��� LICENSE LICENSEDIAS A MASTER PLUMBER MARK B MAGN IFICO 'a Z 31 FOREST STREETAi � a ' MIDDLETON ,� ,{� x�„ SMA 01949-2015 �+ M. 13559 05/o w 6 204667 COMMONWEA OF NPIASSACHUSETTS BOARD-OF a3 : PLUMBERS AND GASFITTERS ISSUES TH` FOLLOWING LICENSE LICENSED AS A JOURNEYMAN PLUMBER " a MARK B MAGN I F I CO ' 31 FORESTST $ z �c W t y ; _j K• fr N -90LETON MA 01949-2015 f� 23002 05/O 1/16 2046$ ; a V�% 3R1 l 0 r' a Date./r�,12�.J'.1 ... .... µORT# 3= '` O P TOWN OF NORTH ANDOVER ..... PERMIT FOR GAS INSTALLATION 9SSAC'#USEt This certifies that . . . �T' . , �tcfnb.• c �` t . . . . . . . has permission for gas installation .fi' `'r-� h fir./4 O in the buildings of . .�6`. at ee'/.,, C. !' '!^. �. . . . . . . . ., North Andover, Mass. Fee.AW Lic. No../G4�. . / GAS INSPECTOR Check# fiZ�(o 7859 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING Clty/Towno�" �'t1�c��4.�" MA. Date: ra 3 t� Permit# Building Location:U►%\ sy4myog c 'Sk Owners Name�MSWLA SA4aCO3,INA Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: [ Plans Submitted: Yes ❑ No [ ] Cv►S��rwVe 'Zi t , �� �. �S� �� FIXTURES � fn z tocnU F— Q m M Lu 2 0 W O W z N 0 w W Z !,— Z30:� W W w 0 ~ H 0 W In W m 0 ~ 0 u� X f1' w ~ Q W w w z w O- W Z w° > W W Z 0 J F' F— O Z J 0 W � = W � w W Z w } lr rn m W O Z 0 F— O Q w W Q > O O w z z w Q H SUB BSMT. BASEMENT —1-sT FLOOR 2 WFLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR ^ n l Check One Only Certificate# : Installing Company Name ;:.n `��+►w�b�n 4 �`t'V t C�S 1 h L ` _1 f� X Corporation Address Vvft" Qct City1Town:\1�AV%f.0`n State:K-L ❑ Partnership Business Tel:Lk's\ 6 `1%-K l Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: r �tr�ck o INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YesNo❑ If you have checked Yes lease indicate the a of coverage by checking the appropriate box below. Y _.P type 9 A liability insurance policy [ Other type of indemnity F1 Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By Plumber Title ❑Gas Fitter Signature of Licensed Plumber/Gas Fitter ®Masterp, Cityrrown ❑Journeyman License Number �.' Z i1 APPROVED D OFFICE USE ONLY ❑ LP Installer li ROUGH 91AS OSrE-CllUN NOTES BELOW FOR OFFICE USE ONLY MAL INSPECTION NOTES Yea No — -- -- ---THIS APPLICATION SERVES ASIff-UJRMIT ❑ ❑ _ FEE: $ PERMIT N — ---- rLAN REVI M NOTES -- 9157 Date.A/`�:S.h". . 701 TOWN TOWN OF NORTH ANDOVER �? •`,, 0 PERMIT FOR PLUMBING ,SSACMuSE� ' This certifies that . e�?.210'4? . !h D /r has permission to perform . ./I'���J/�'. .�llf.�� . . . � . . . .. . . plumbing in the buildings at. .. . . . . . . . . ., North Andover, Mass. Fee32�-?v.Lic. No.. l4�� '. ///L . . . . . . . . . . . . . PLUMBING INSPECTOR Check # &Z?.SY! i MASSACHUSETTS UNIFORM APPLICATION FOR PERMITTO DO PLUMBING City/Town: , `c Nn OY�,Y' MA. Date: V� 3 \\ Permit# ` O Building Location-4 G\ JkA'I'nM VC S� Owners NameR\H551.`\ Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional❑ Residential New:❑ Alteration: ❑ Renovation:❑ Replacement:Q Plans Submitted: Yes ❑ No �1'l ' Z.S�S 1 S FIXTURES DEDICATED SYSTEMS W Z VI W ]� O D W in ut Q y >- `� V H W Cr Z a J V D: W Q Vf Q fY �n , H Y v1 Z C Q w ©,�/p Z , W or Z .~ W FQ- C 0 a Q L? ~ Q /y �S m V1 F-LU 1A } W - Y Vf C7 -j _ _J 3 ✓ ,� O Q W 0 Q W Q 0 d W U, J Q Q: Orf d W W Y� O S LL S W W , V b� W u H = a O F- U Z Q 0 a Z Z v1 H 1- W _0 LA W Q} H W Q Q Vf Vi O F p = O Q Q Q Q U Q cc OG Q LL = s: g 5 0: H v, 3 3 3 0 a 0 t7 0 3 SUB BOO. BASEMENT 1ST FLOOR 2"D FLOOR 3"D FLOOR 4T" FLOOR ST" FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR �� `` \ Check One Only Certificate# r Installing Company Name:((�TE.� Q�V►M`P1r14 SQ-�t"V��-�S `NC, \\ n 5Q Corporation Z%gq Address U- Cityn /Tow \t"z-zA State: OZ'%C. ❑ Partnership Business TeI:1j%O\ 403t\ \VSt4 ( 1Fax: ❑ Firm/Company Name of Licensed Plumber:?r Q k Lr I.Q 1c Ay) oX`n C%W\ INSURANCE COVERAGE: I� I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes xaJ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title Plumber Signature of Licensed Plumber Master O\ r city/Town ❑Journeyman License Number: ` �D APPROVED(OFFICE USE ONLY I f jOUGII myU wIlYG INSPIiCTm NOTES )BELOW FOR OFFICE USE ONLY FINAL INSPECTION NO'T'ES Yes No —THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REYIEW NO ES - s Date....L....3......l.Z.,.. NORTI� J -i�'11ihOpL TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SS�ICMUSEt This certifies that .......1.. ..... ....441.. ........................................ r has permission to perform ...... ... wiring in the building of................................................................................... at.. .....;. .........f ........ ,North Ando Mas . Fee./, 4?......... Lic.No./0s �I.... ��- . ...�. .. . .. 9910 RICAL INSPB♦ R t, Check # �� 0.6 . (.om»tonwealth of VadeacLdb Official Use Only Apartineut of ire�ervice� Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] leave blank L APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ,527 CMR 12.00 1 TIN (PLEASE PRINT IN INK OR TYPE ALL IN. TION) Date: I ;LO City or Town of. Al / vc/ To the Inspector of Wires: By this application the undersigned gives notice his or her intention to perform the electrical work described below. Location(Street&Number) LI U 1 � �� 5'F Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building ISciS�,� .� i t�"�, Utility Authorization No. • Existing Service .�0o Amps ,t / .?/a 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: L > ,S 6 Coo J* .✓<<✓ cy She►+rnfT �/-✓/o u1 re(YIS Lisk. l Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires [ No.of Ceil: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- E] No.of Emergency Lighting rnd. 2rnd. Battery Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of AlertingDevices Tons No.of Waste Disposers Heat Pump Number Tons KWNo.of Self-Contained Totals: Detection/Alertin2 Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: i Attach additional detail if desired,or as required by the Inspector of Wires. 4 Estimated Valu of lectrical Work: 0 0 (When required by municipal policy.) Work to Start: ,70p-- 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 thea' s ndpenalties ofrjury.that the information on this application is true and complete.A� FIRM NAME: f/'I LIC.NO.: lye Licensee: v Signature LIC.NO.: 6 (Ifapplicable,enter "exempt"in the license number line) Bus.Tel.No.: ,1 y Address: Alt.Tel.No.: 03 J°t / *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 agent. Owner/Agent w Signature Telephone No. PERMIT FEE. $ 3 U- ` 1 1 GDMMALTH OF MASSAGiiUSETTB ONWE ELECTRICIANS REGISTERED MASTER ELECTRI,CI. ISSUES THE 5139VE1ICEr4SE TO GLEh1N M�SILVA I; 222 BOG :BRUDK .RDtR NEW BOSTON ,,;NH 03070 501 105GMR 07/� . . ,.... 1/13no . .8,70651; . , CONTROL# H 0 6 5 5 7 9 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710,Boston,MA 02118-6100. If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next I Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended. It is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. Date........... ...a....... .. NORTI{ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ��Ss^cMusE� Thiscertifies that ..... ...:.......... .. ..................................................................... N , I(' t has permission to perform ........ .....................TY wiring in the building of :: :''......... at.............q..6-1./..........0 'l .:. '...: .., ort Andover,Mass. �t d 4 Fee..jj��//.`.�ep.. Lic.No. ....y� d r�,` J } }ELEO�fRICALINSPECTORf �� Check # � j, j 9 0 5 G Official Use Only C'omanoruueaR of/f a9dacl ief Permit No. ti may, 2( parhned o - ire service4 Occupancy and Fee Checked BOAROF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) — APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pertorried in accordance with the Massachusetts Electrical Code(MEC).527 CIMR 1 .0o (PLE<ISE PRINT IN Ai 7K,OR Ti PEALL 1l\'FOR.AL4T1O V) Date: 5)4 /0Y City oi- Town of: �N of- 44N ���_ o the Inspector of W,7-es: By this application.'the undersigned gives notice of his r her intention to perform he electrical work described'below. Location (Street& Number)V #-fLp ( �Z i Vy-' fie. r Owner or Tenant K Telephone No. -7 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ® (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 deters aild Ampacity ---- Location and Nature of Proposed Electrical Work: J Completion ofthe following table may be waived by the Inspector of Wires. ti No.of Recessed Luminaires No.of ranssformers KVA Ceil.-Susp.(Paddle)Fans IT `TrVA No.of Luminaire Outlets No-.of Hot Tubs Generators 1 KVA No.of Luminaires ISwimmin'Pool Above ❑ In- ❑ 'o. o Emergency Lighting Swimming arnd. grnd. Battery Units No.of Receptacle Outlets INo. of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No. of Detection and Initiatin Devices No.of Ranges No.of Air Cond. total No. of Alertirt Devices Tons g No.of Waste Disposers Heat Pump Number Tons J.KW No.of-Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑_Municipal El Other Connection No.of Dryers Heating Appliances KW Securi Svstems:I -7 7 E uivalent No.of Water KW No.of No.of Data Wiring': Heaters Signs Ballasts _ No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: 77 C� ���� 3,3 Attach additional detail if desired, or as required by the Inspector of tt'ires. Estimated Value of Electrical Work: �� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rule 10,and upon completion. INSURANCE COVERA E: 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:) Self Insured I certify,under the pains and enalties ofperIur ,that the in mation on this application is true and complete. FIRM NAME: ADT Security Services _ LIC. NO.: e -�S Licensee: Mark A. Brophy Signature ' C__ LIC. NO.: C-45 (If applicable,enter "exempt"in the license number line.) 513us.'Tel. No.: 603-594-5-928 Address: 18 Clinton Drive Hollis , NH Alt.,Tel. No.: *Per M.G.L. c. 147 s. 57-61 security work re vire " q s Department of Public Safety S License: Lic.No. 00953 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 ❑ownria ent. Owner/Agent Signature Telephone No. JPE RMIT FEE: $ - A 1 ���c �o�n�nra�acaeallli ��/`/.aeapc%uae�6 DEPARTMENT OF PUBLIC SAFETY ,'.S-'LICENSE l Number: SS CO 000953 Birthdate: 02/07/1958 r Expires: 02/07/2009 Tr. no: 187.0 S-License: ADT SECURITY SERVICE MARK A BROPHY SR 111 MORSE ST NORWOOD, MA 02062 C Commissioner _ DIG SAFE CALL CENTER: (888)344-7233 Fold,Then Detach Along All Perforations �\ COMMONWEALTH OF MASSACHUSETTS BOARD OF ELECTRICIANS ' FA REGISTERED SYSTEM CONTRACTOR R ISSUES THIS LICENSE TO J ' TYPE ADT SECURITY SERVICES, INC. MARK A BROPHY SR —C 111 MORSE ST NORWOOD MA 02062-4602 353795 45 C 07/31/10 353795 Fold,Then Delach Along All Perforations law t Date.... /..``.:................ ,�/ 'p 'R toRTM °!,�``° '•�"° TOWN OF NORTH ANDOVER 3a - o� r p PERMIT FOR WIRING CHU M This certifies that .. ........ ' ..... ....................................... has permission to perform ..,...f1..... wiring in the buildin of.... f !- r�....... �...............�`...........�, at. f......,.... ,....... ...:: North Andover,Mass. Fee-.-L//'-<'•....J....... Lic.No��jc�t.C�............. .: ... ELECTRICAL INSP �r Check # 8458 Commonwealth of Massachusetts Official Use Only �i Department of Fire Services Permit No. Occupancy and Fee Checked `fQ�^`� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 11-4 -06 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) 46 1 u rm m of ee+ Owner or Tenant F(L'` 6ZA61P Telephone No. Owner's Address SAM-C Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Buildingell,),J 01i Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service" Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Feeders and A Number of mpacity Location and NatureofProposed Electrical Work: WN,t2e 5e(1 C,)pU M C 1 ' (oA4 Su.)1"1 fU�e5 rAA, Cor- \YLOJ &0g.1 Com letion of the followingtable inay be waived b the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool nd. ❑ nd. ElBatte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump .umber.Tons KW No.of Self:Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent i No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent 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: (When required by municipal policy.) Work to Start: 11-6-05 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 p the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coy rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the ams aild penalties ofpgrjury,that the information on this application is true and complete. / FIRM NAME: AV 1 1'`QQ VI U V1 LIC.NO.: �/A�P A Licensee: ,�'p,(vl t, Signatur LIC.NO.: (Ifapplicable,enter"exem t"in the license number ine. ll Bus.Tel.No. Address: 4' ��u� ��`D lz 1 V �Q to d ty MA, Alt.Tel.No.. /gj *Per M.G.L c. 147,s.57-61,s curity 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 Signature Telephone No. PERMIT FEE. $ 4is. Date. � NORTH TOWN OF NORTH AW/OVER PERMIT FOR PLUMBING ,SSACMUSE� . This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . `�.`.'. . . �t �.� . . plumbing in the buildings of . �' . ' . . . . . . . . . . . . . . . . . . . . . . . at . . 6/ 5(.�. . . . .`. .. . . . . . . . . . . . . . . .. North Andover, Mass. Fee. .. . . . .Lie. No y 7 . . . . . . . . . .'E-'-. . ' t �'�/ice-. . . . PLUMBING INSPECTOR Check # i 7923 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location Date Namet"��b Permit# Type of Occupancy Amount 6 Tol 3 New ❑ Renovation Replacement ❑ Plans Submitted Yes ❑ No ❑ FIXTURES o � � o x o a � q U C7 o C� SL&A9.VjC '�rte, 1 1Slr FIAQ2 M Him 3M ILOM 4IRFLOM 5M F10M 6IIiFIDCIEt MR-cm - M FLOCIR k (Print or type) Installing Company Name L— �1 �'� ' N S.lL � Check one: 3 �Certificate E-1--corp. Address y fywi Y � ) ❑ Partner. Business I elephone ❑ Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate th e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver. I, the undersigned,have been made aware that the licensee three insurance of this application does not have any one of the above Signature OwnerEl ❑ Agent I hereby certify that all of the details and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and instaRatio s perfo ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass ach P b g Cod and Chapter 142 of the General Laws. By. SignaLuTiFTF1 icons um er TTp4o P mbing Title ��,, License City/Town cense um er APPROVED roma usE oNLy Master Journeyman F1 f o'7 .421 S" WETLANDS DELINEATED FLAG 3 BY OTHERS SEPTIC SYSTEM AS—BUILT Do LLJ FLAG 5 FLAG 4 J LOCATION: 461 SUMMER FLAG 6 ,.• � STREET FLAG 7 - NORTH ANDOVER, MA �_�____---o-- DATE: 12-1-08 LL f° SyFD SCALE: 1" = 20' ° A TO D 31.1' (D= DBOX) A TO C = 31.3' (C = SEPTIC TANK) ° A TO E = 26.6' (E = PUMP TANK) 8TOC = 21.8' N \F GATTIS BTOD = 47.0' ° POOL ti B TO E = 29.1 INVERT FOUNDATION = 78.55' s INVERT TANK IN' = 78.30' Qj INVERT TANK OUT = 78.05' p INVERT PUMP TANK IN = 77.99' c '�j INVERT PUMP TANK OUT = 78.25' DECK INVERT D—BOX IN = 83.98' ° PORCH INVERT D—BOX OUT = 83.81' INVERT LINE BEGIN = 83.70' o---o GARAGE INVERT LINE END = 83.70' No. 461 _ 1 CERTIFY THAT THE WORK ON AN ON-SITE SEWAGE NO FOUNDA e NCHMARK BOTTOM / WITHOTITLES5 TEM HAS BEEN DONE IN ACCORDANCE OF SIDING--80.00' IDING-80.00 100BUFFER ZONE A �, w � res ` #1=80.79' Al o � f o DEC 0 5 2008 TOP WALL ® HIGH POINT 84' ~ ^ t,5oo �? GALLON. INTERLOCKING BLOCK RETAINING WALL N C TANK . W o t Tey ,{, ;w,-;;� P N O 36' E PROFES ION LENEER ..� r "r'u iENT A 2m 2. �4 Eli GA�OM•ANK D PUMP o DATE; 1Z 11 OB • D-pOX � P/ 0 mll HDPE5' SAND �• BARRIER ENGINEERING & SURVEYING v ooa 77.06' lP FND. SERVICES 7s.5o' G>� >�� 70 BAILEY COURT 20 '° ER STREETHAVERHILL, MA. 01832 s UMM °' 0 - _ — 978-556-0284 oDate......y-C.................... _ 1614 N°RTPI r o?°;��``°.,•.;"o°� TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACMUS� This certifies that ........................ �........................... ........................................... 'e. e-t � .11 `�: `.has permission to perform cp .................... .... . 5 .-.-f...... wiring in the building of........... ...............:....................................................... x , 40— t ...... ,North Andover,Mass. Fee ........ Lic.No��y�7..`, ...... :............. ELECTRICAL INSPECTOR 04/20/99 14:44 25.00 PAID CIK W WHITE: Applicant CANARY: Building Dept. PINK:Treasurer 11r, ThFC0"'10AWE4L7H0FA&M(Y1, ';LZ Office Use only , DEPARTM 7VT0FPUBLIC&4= Permit No. lel BOARD OFFMPREYFM70NREGUL4T10YS527lIO 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 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant Owner's Address � f Is this permit in conjunction with a building permit: Yes 94 No ❑ (Check Appropriate Box) Purpose of Building 4 � 1 Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Underground ❑ No.of Meters New Service Amps / Volts Overhead ❑ Underground ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work of Lighting Outlets No.of HOt Tubs No.of Transformers Total KVA N6i,.of Lighting Fixtures Swimming Pool Above Below Generators KVA and ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Bumers 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 Detecrion/Sounding Devices No.of Dryers Heating Devices KW Local ❑ Municipal F7Other Connections No.of Water Heaters KW No.of No.of 7 Signs Bailasis No--gdro Massage Tubs No.of Motors Total HP /-�� A OTH �3 / 4 x� . ER• - —.�e1 // IrmrarreC.aeraa�Ptasljare>nthet�tmana��Ger�ealLaws - lYmeacmatLiabtkyhmrancePabyinduhngCaTplele Corca critsstt legzmiat YES E NO F-1 Iha esutxnaied,,aWproofofsarnetot rOffm YESNO ❑ � _ Ifjcuha�echaicedYES,plexer atetheN)ecfw&aWbycft,the Micpri*bcx INSURANCE BOND ❑ ❑ (Please SPAY) Eq;ratiat Dai F-gim�ValuedBecaid Wok S Werk ioSta<t —� It Cxiat Dae Requested Rough �?� Finai Signed un,3XTZ ofpajtay FIRMNAME LixtseNa Li ts' Si.. Z,2!fz 101 Busatess Tel.Na AIL Tei Na OWNER'SL� WAIVER,Iama,,=thatttreIigTsedoes not Mvethe aardmeam=Vo-z akqyt6 e7nniaiasm medbyMssa±L� Cmffaltaws and that mysigmieatthis P=Itappkabonwai-esthis m4zanatL (Please check one) Owner ❑ Agent ❑ Telephone No���l��PERIviIT FEE S Date J/K?-.0P—/.1??� X11-2 3908 NORTp •o,;.;;tio TOWN OF NORTH ANDOVER 00 PERMIT FOR PLUMBING ,SSACHus� This certifies thatu !. . F has permission to perform . A� . . ! 'r...Q�'. . . . . . G plumbing in the buildings of ... ... .. . . . . . . . . . . F at. /. . -t!�!? `. .... . �i A , North radOver, Mass. *"- 03.1 Fee! -�'�.�;. . . .Lic: No. 3C?. . t PLUMBING INSPECTOR i t -k#, • `� 35.00 PAID r 01/12/99 14: WHITE: Applicant CANARY: Building Dept. PINK:Treasurer or Print) (Type ;::�• ;i;.•, ,;�,' . NORTH ANDOVER ,Mass. ::, ; Date • 0} B 'Iding Location / Sv/1, ;e,� %c S Permit 13%08 Owners Name v New 'D Renovation ' ' Replacement Plans Sybmitted FIXTURFS ' ' z z of z x < to 07 os O z ~ > a W Y J P. d V r to O O ¢ Q O z w a .� D. LC W H 1•' W < Q1 O .J Y) Q !r J 0 iC 'G W AC W < Y 3: 0 x T Id Ix O N 4 X < W k IC W > 1- o Z a O N 1-- z o a3 x z w h' o V = • < < < z to a a o a o < it ac ac < o < t•- >< J m O O Q J = H to W O 7 O < 'C t0 0 Sub—,BSMT. s BASEMENT ' 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 6TH FLOOR 6TH FLOOR 7TH FLOOR ' 8TH FLOOR (Print or Type): Check one: Certificate Installing Company Name( Corp. Address v<r- 47,w �� Partner. Firm/Co. Business Telephone 3 �7 Name of Licensed Plumber: f6,X? y�- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type ,of indemnity 0 Bond L Insurance Waiver: I, the undersigned, have been made aware- that the licensee of 1 this application does not have any one of the above three insurance coverages. ♦ Signature of ownerlagent of property Owner Agene,-. 0 l bsteb txttif Wa!all of the dctails and infoinulion 1 luvc suipuniltcd of cntcicd)in aM.vc a y of r r l rpliotiow a;,e htsse assd ats a w.beat r • kstawkdts aad that all plumbing work and installations locsfaimcd undo rcrmil I%sucd for this appliati"with rs it pM1p1(iwp s~�W(gthllitK Owl tryaioau of abs kaasa4mactia Statc Pluwbiaj Codc and Cluptct 141 of tlic(:cnual V«L By C- Title . Signature of Licensed Plumber � I w city/Town: 3Type of Plumbing License A 0D0r)VFr1 7oFFlcF USE ONLY1 License Number 61 Master QJourneyer Location 1461 s b m m e l 7�* q No. /0 Date I a 1400 TOWN OF NORTH ANDOVER Certificate of Occupancy $ • ; ; Building/Frame Permit Fee $ aff sACMUS Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL (/ b Building Inspector 12 .0151 01/27/99 12'29 25.00 PAIDDiv. Public Works 61 tIJINv11U 111vH+:i 1N:lJV(I:ILIIN' IIV1%)HARM(IA):1 I1.1VN:) p)I ra.ww ` f q 13t 111 X)J 86616 i NdI^ � 1' 1:11.S113NMt) 17777 _41.1S"1 JNI11'111)0 tx)JJ3JSN1!)NIU HIM AU U3Ao &IJY UNY U3 113 30 1Sn14 SNY Id L1011J.\V)L►aY '( SNt)I1.v111!)3a3H1331VJSOJ.tVHU3NOJ1SnWS3UVaVU(1311JVUV OtJ J IIV1:13d JI t.13S ON10 1111U.-K)3(IISI.I X)NV 30 1SnW S113J314JIHJJ3 11 tvt x)H H1.1.1 9r.).-) '!X I IO 'J S3 pA� -la 'OS IJ_W J.S()J'!XI lU 'J.S3 1 C'1 SNOI133S J)10'1113 1 39-,d J.190J '!XIIR'Isa Ir LS�)JUNVI � NVLLYIV11VjN1 .l.l.)13.IUHa 'C SNV1.1..MISNI ✓ / 3N1'I SVJ'IVHIII..VN 0.1(1.1 U)3NJUJ'JNIU Itins SI ^ Q 1/ HIMdS NM01 O.I t131J3NNUJ JNH111f10 S1 Z. ANY 31 'I CALDV S1V v jO(IHYO{i 51 1131VMt1MVI01.U3lJ1Nr)r)J'JNKIlit InSI 3u()J3rJS.IN9"3111110311U1WH03)JOJDIM 111n0 lllvl (INVA 0:11113 Ill)(11 US N()!)NKI)ing sl ) % M)I1VN31W DNKJ 11N9 S1 A3NIVtllJ3O'IVIH3IVH O M11KKJY!)NIU'IIfIll S1 f� 7JN1TAX)130FI21S � M3N!1NKI IIIlt151 SSaN:1 1111 rxHtv(xm)()3.A1nrJl-tl a9VI"Mi JnI X)Y:)HY S113t►HI!)3U SN()ISN31VIu aV3a S3tIIS-S3"11 10 11VOaJ a-)NYJ SH I S19><I Jtl SNI)ISN91V141 1391,11S PAM I3.)NY.1SHl: S I ITS II)S")ISNjIVK) T !)r11U Itn11.LS3HY3N013,AJYI SIU NY.Is 31-ON S,HJt1 111111 SRI 1 f Z I SH-1111'411 IA X)IIA):T1IS �) 4-1"/ � 31YYNS,IJ3111i�HY A ( ® <'YP) � � IIY IS 1K ?�)1NlIViSVU ✓'� /x�•� S 41" n SS-IMItlY S,a:INMI 7 Sn)x)1S X) (Its :� 11wNS,HaN,�tr) �y i* �U ��t'�7 !)NHIIIr1It.�r In�t1111J Q'`, a��W/pn NI SIM 7 711 Y 111 1 I,. — -�U'l/Y1 _ '1)N 11)1 '.111t(lits l V7 r/ ��`�� `IUOfl 31Y(1 .IIIICII IN.NI) IIIIIHII.)IH 't '1)N'llll J/� r�uN.n�'4 V1A1 tP1 11 A (1(1Al\; 11 1 1lllAt.. rt t t (lil 1/l I_-_LLII1\I;l t �tr>.t *1rt)_i_t�11'i.1 tt1_ ���1 t t taU1=.t FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION "./ APPLICANT D �kA9 PHONE 7 L LOCATION: Assessors Map Number PARCEL '1 SUBDIVISION LOT (S) t 4 STREET ,S 0 M MCA ST :'' ST. NUMBER4� 1 OFFICIAL USE ONLY*"* RECOMMENDATIONS OF TOWN AGENTS: - CONSERVATION ADMINISTRATOR DATE APPROVED DATE-REJECTED COMMENTS TOWN PLANNER DATE APPROVED rl� DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED S t)d IIS ECT0R-H EA T DATE APPROVED / DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT " f FIRE DEPARTMENT V RECEIVED BY BUILDING INSPECTOR DATE Gable Wall ' - 27�'8 - h4W i I i M Fred & Eiilieens Master Bedroom 4" T1 Q I i � I 3 { 2Q Existing Bathroom i Chimney U.+ o o. (>a Hall [] __ ' L TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Typeit/ Aof Work: R l'l� /NS4al1 �3AP� Est. Cost Address of Work Owner Name: Date of Permit Application: / 21, ` q 1 hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied _Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: ate Owner Rbme li i 4,. �.--�c,�-. .�3� �____.-•fes- :.. `_�___�_/�'i�?'��_,�,._�.�.�.�1�+✓ .+<.���� Al i I I f _ I e L � / I � F t4OR T Town of dover No. * i � 0 s dover, Mass., 0 LAK CM ICHEE �i-y�A WICK �4A TE Ds pP�y BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System r� � C, �� � BUILDING INSPECTOR THIS CERTIFIES THAT..... ................................................................................................................................................... Foundation 14 (has permission to ewf.. N.14.k .' ..... buildin son ...... ..�.........5►. ..w►...K t r.. $a ....... Rough of r� ..Aj�A .!.... ... .... IN � .. ���.I.. ..... � �.r Chimney to be occupied as... .......................... I 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 Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Z e PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR 1 a °t 51 UNLESS CONSTRU N TfS � Rough ..... .... ... ...... ............... ................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display n a Conspicuous Place on the Premises — Do Not Remove Rough P Y iP Final No lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. t ocation N Date f pORTp , TOWN OF NORTH ANDOVER . _ n Certificate of Occupancy Building/Frame Permit Fee $ r CwusEth Foundation Permit Fee $ t: .r' Other Permit Fee $ ' . Sewer Connection Fee $ f; Water Connection Fee $ TOTAL $ Building Inspector !x01 6 aw PAID Diva Public Works = } t_ocatlon N$. Date f pORT� TOWN OF NORTH ANDOVER ' O �•0 1 Certificate of Occupancy $ ' Building/Frame Permit Fee $ ` s�cMUsfth Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector ? � 25.oo PAID Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO 13UILI)********NORTII ANDOVER, MA AI P NO, LOf.NG, 2. HECORD OF OWNERSHIP DATE BOOK PAGE LINE SUB DIV. LOT NO. I.D('AllON P(IRI'(7SE OF FIFAI DIN(i NO. Of ST(N(IES SIZE OWNERS NAME OWNER'S ADDRESS BASEMENT OR SLAB ST ND ARC 1111'FCI'S NAME ' SIZE OF FI.00R I UMBERS 1 2 3 BI III DER'S NAME SPAN DIS I ANCE*10 NEAREST BUII DING DIKIF:NSI(NJS OF SILLS DIN FANCE 1 KONI STREET DIMENSIONS OF I'OSI S DIS ANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA(.f LOT FR(N IAGE IIEiGl IT OF FOUNDATION THICKNESS IS BUILDING NEW SILL•'OF FO(IFINC, X IS BUILDING ADDITION j MATERIM.OF Cl IININEY IS BIIII.DING ALTERATION IS BUILDING ON SOLIDOH FII LED LAND W11 L BUILDING CONFORM TO REQ(IIREMENI S OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEAIS ACTION, IF ANY IS BUILDING C(NJNECI1:1)TO TOWN SEWER Y IS BUI I_DING CONNECTED TO NAI URAL GAS LINE �'�STE: IWFIONS 3. PROPRFI' INFOR�I.ATION LANDC(ST ""�1 ESI. BI.IXi.COST PAGE 1 FILLO(ffSEC1IONS 1-3 EST. BLDG. COSI PERS(?. FT. EST. B1 DG.COS f PER ROOM E(ECTRIC METERS IAUSF BE ON Ot)I SIDE(N BUILDING SEVI IC PERMI I NO. AFUACI IED GARAGES MUST C(NFORN1_FO STATE FIREREG(ILAII(NIS a. APPROVED BY: PIANS MUST BE FII.ED ANI)APPROVED BY BUILDING INSPEC-FOR Bllll.l)1 :INSPECTOR I).k1:FI11:1) \�Q \ OWNERS]1.1 \\ CON IR.lTla (� 2--21-Z-66, till;N. _OI:OWNFR(W At I IItN21LFD A(llfrt— IL1.C.a I'll.R1.11f(IRAN IFI) 19 — 0ORT '416 Town of _ - Airldover No. � m C2a� - 4 . _ _ - - z _ dover, Mass., 19 0 s LAKE ice: '9-COCMICHEWICK '�• v BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT................................................... ........../�.�� _ BUILDING INSPECTOR _ Foundation has permission t0 8rect.......... . btti# 1iR,J�O�T. /(0 f �/[�/ /jy.. ` ...... Rough to be occupied as............................................................ �.. ...... Chimne........... y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR Rough ................................... .................... .. ..... ....... ......... Service BUILD INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det.