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Miscellaneous - 47 HUCKLEBERRY LANE 4/30/2018
/ 47 HUCKLEBERRY LANE 210/065.-0219-0000.0 zuizr assacnusetts.ElectricalCodeAmendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the rescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an + electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall_be limited as to the time of ongoing constnrction activity,and may be_deemed-by.the.Inspector_of_Wires abandoned-and-invalid-if he—_. ._ or she has determined that the authorized work has not.ommenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or.the installing entity stated on the permit application. • _ .6 The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending'through August 15,2012. Rule —Permit/Date Closed: .41&111***Note:Reapply for new permit 0 Permit Extension Act—Permit/Da a Closed: Datel. .� ... 6 Of �aOR7:1,I,0 aj oL TOWN OF NORTH ANDOVER p PERMIT FOR WIRING . ;, ACMUS� This certifies that tom :.... �'.����� ' ......................... ................................ has permission to perform /4&t�i.... i !. .. ....................................... wiring in the building of... ...7. f... ........................................................ at.. ,�. ........�!�'`'1. ''i .................. .. .North Andover,Mass. Fee . ;....... Lic.No..1 d. ........ .................. . ...r � ELECTRICAL INSPE R Check # 9250 Commonwealth of Massachusetts Official Use only `%�� Department of Fire Services Permit No. Occupancy and Fee Checked 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: 2 /Z / /Q 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) y 7 Ji/G k l e rV�YI Owner or Tenant 4V Y- Telephone No. C 7� - Owner's Address 7 ALA-i C z-e V (p, 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 Meters Number of Feeders and Ampacity / r Location and Nature of Proposed Electrical Work: ` r 5`5- 7' ti Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires f No.of CeilTrans.-Susp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA N—oNo.of Luminaires 'Z Swimming Pool Above ❑ In- Ela o Units ig mg rnd. rnd. Batter Units No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches /"� No.of Gas Burners No.of Detection and J Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW4 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 f No.of Water KW No.of No.of Data Wiring: Heaters � O 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 M" ',s. Estimated Value of Electrical Work: (When required by municipal policy.) l 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 unlet the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. They 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 thepaiw andpenalties of per*ury,th�nformation on this application is true and complete. « FIRM NAME: J S L LIC.NO.: Licensee: rL I 1✓ Signature LIC. NO.: � (If applicable, enter "exempt"in the license n ber line.) Bus.Tel. No.:CO 3-5.2g,-.2,9,,K Address: C e�' er l2a.� �/� tV 7 Alt..Tel.No.: *Per M.G.L c. 147,s. 57-61,security work equires epartment 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 anent. Owner/Agent Signature Telephone No. PERMIT FEE: $ `� Date. . a . . . ... . . . HORTM 3=0*. ..�o ,e�tioL TOWN OF NORTH ANDOVER O D ' PERMIT FOR GAS INSTALLATION �qS CH E�t , w This certifies that . �/? . . . . . . . . . . . . . . has permission for gas installation . . . A,.�. . . . . . . . . . . . . . . . . . . in the buildings of . . .`'�r.�, �1�h.�./ . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .1/. 7 . .//c.<- Xr.4,.ke P. :i, , , , , , . ., North Andover, Mass. Fee. Q. Lic. No. ,� .'/�.�. ... . .�- .:� . . . . GAS INSPECTOR Check# 2 c2 r/y 725 ) .4 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations 7 � � r % %.= he n et << Q Permit# /- Amount$ n A Owner's Name New Renovation Replacement Plans Submitted � w � o a w c U H x H w c o a c z a w x z �" o x > w o H z H g H F W o w °w a w a w < .. > o 0o z o w o x z 3 0 a a > c a o SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8.TH . FLOOR 1 1 1 -99 (Print or type) Check one: Certificate Installing Company Name �e ✓,. j .'4 A) ,� /�/ ❑ Corp. Address �Z/ 6 &Zd Ad a%— Partner. PPC/ /" Business Te ep one o? A O'Firm/Co. Name of Licensed Plumber or Gas FitterT/�fl Awe c INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes r7l--`--No® If you have checked yes,please in the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 13 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Signature of Licensed Plumb Or Gas Fitt _ Title Plumber �� City/Town Gas Fitter icense ElMaster APPROVED(OFFICEUSE ONLY) ffr"nlv�eyman rl The Commonwealth of Massachusetts Department o f Industrial Accidents Office of Investigations Uf 600 Washington Street Boston, AfA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPHeant Information Please Print Lea><bly Name(Business/Organization/Individual): j—�jo/na c Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. �o workers' comp. insurance 5. 9 ❑Building addition p. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp, c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] .13.[1 Other ;Any applicant that checks box#1 must also W]out the section beiow sh.^wing t�hei.worx=,compensation policy information. ;Any 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 workers'compensation insurance information for my employees Belowis the policy and job site 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 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 certify �kdlerf*he pain id penalties of perjury that the information provided above is true and correct Si atu : Date.: Phone#: [6. ficial use only. Do not write in this area, to be completed by city or town officiaL ty or Town: Permit/License# uing Authority(circle one): Board of Health 2.Buildinb Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Otherntact 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 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 coxnpliance with the insurance coverage required." Additionally,MGL chapter 152, §25CM states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their cer dficate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers' compensation insurance. If anLLC 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 be returned to the city or town that the application for the pernait 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 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 burn leaves etc.)said person is NOT required to complete this affidavit. . The Office of Investigations would like to_thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 emit 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-72.7-7749 www.mass.-gov/dia ENGINEERING, P.A. e-mailed 8 February 2010 Mr. Steve Schade DeSandre Builders 1014 Union Street .Manchester, New Hampshire 03104 Re: Mu 47 Huckleberry Lane, North Andover, MA Dear to As you requested, SW&C analyzed the triple 1-314"x 18" LVL beam above the family room and the three double 1-314" x 9-114" LVL beams above the dinette at the referenced.project. All four members are capable of safely supporting floor, attic and roof loads as required by the current Massachusetts State Building Code for Single and Two-family Residences. Please call if you have questions or need additional information. Very truly yours, ROBERT P. � �C44VflC STRiJC11J n4 �o.33566 quo �FG1ST cfg�� ` Robert P. Brecknock, P.E. • STRUCTURAL DESIGN• 857 Wellington Road, Manchester, NH 03104 (603) 645-1392 Fax: (603) 645-6586 7 4 Date,/?/��/,1�.... ... . WORTH pf ,ao 1.40 TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION . y gs1SSACH USE4t This certifies that . j.,�... . . . . . has permission for gas installation . Ler. .: .cF. . .�� . . . . in the buildings of . !S: at .�jl�.{ 1r.Pf . .� .�a h Y. . . . . . . . . ., North Andover, Mass. J Fee. 30. - Lic. No../ G S INSPECTOR6J�hT� Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:/)k An cL u-6� MA. Date: 704�z -� ?-^1 Permit# Building Location:`'T 7 �/UC I�Q ���r Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New:V Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ NoIZ— FIXTURES LU Cd Z � cn v = Q F- m = OW W U CO H O = W W Z H Q~ (9 -j >- W Z U) O 2 w w U) w W w m 0 a a H o W w X W , CO) O W W W Z 9 to = w W 1-- w 0fCe 9 V w Z O J H 1 O Z --1 (9 LL N = W W W Z W N J Q Q m w O z 0 ~ �' ~ SUB BSMT. BASEMENT 15T FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR ����1 C G ��-cs Installing Company Name: Check One Only Certificate# 2 _ y d [9�poration Address: 3/ S City/Town:/l�k4 State: El Partnership Business Tel: ��^�3C� Z t '3 3 Fa)t: /cl7$ -3 O /3-0 _ ❑Firm/Company Name of Licensed Plumber/Gas Fitter: eu INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy [L]� 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 By checking this box❑;I hereby certify that all of the details and information 1 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. Typo-of License: By n Plumber Title ElGastFitter[Master Signature of Licensed Plumber/Gas Fitter p Cit /Town ❑Journeyman License Number: City/Town APPROVED LP Installer OFFICE USE ONLY El The Commonwealth of Massachusetts c I Department of Industrial Accidents 1. Fit It. In Office of Investigations 600 Washington Street e« Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeiziblY Name(Business/Organization/Individual): /'f `l�`�� l��f /✓`�J �` Address: City/State/Zip: S-tv( t" 4" Phone Are you an employer?Check the appropriate box: Type of project(required): 1.k!j�'i am a employer with 4. ❑ I am a general contractor and I 6. ❑Newconstruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # - 2emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9• ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.F1 Roof repairs insurance required.]i 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#0 ,6,4 U Q S3 7 d Expiration Date: 3 1-2Y �l Job Site Addres�VGC-rnrC&o 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 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 certify under the pains and penalties ofpeijury that the information provided above is true and correct.' Signature: ��� Date: cG e- Phone# Z 5phone# Z s�� 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as ...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and.who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or.on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)naine(s),address(es)and phone nuinber(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the, members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the 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 pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple•permit/license applications inany 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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFB Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia i 1 a � '4 '� r x .w k;� i a ,. Y �,.'� }�vy r,�, ern,: y'"+��'✓,�5 t � � - er r s e z 's " �uxfi LICENSED'.AS A JOURNEY.M�AN:P.LUMBE , �4rp� a � �' ? y HE ABOVE LICENSE TO; ISSUES T . t g MAGNIFI:CO + �, " G=�AR A` 31 FOREST ST �. MA 01:944-2015 �1IDDLE'T0N f, � r 784 77' 0.1/12 ` 25110.2 05/` ------ i' F t��yy a 22 � s s M l I x�r 1 n A IC�1 5 J yd x x i' 4 Date. .. .I/� �'.".O RT TOWN OF NORTH ANDOVER �' •`-_^' -,.,�.°oma PERMIT FOR PLUMBING ,SSAcm This certifies that . .,F�?�Z.`��n��.!p. . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . II. . . . . . . . . . . . . . . plumbing in the buildings of . . .A?? ��' '. 1./. . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . .I North Andover, Mass. Fee. .y 7 . . .Lic. No.. . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 8404 00 r ` MASSACHUSETTS UNIFORM"PLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /7 Date�� Q Building Location �� �`� � ,.1 Permit Owner /' Amount /9-N�"l � f1 f /� 1!1 /A t'1 l� n New Renovation Replacement ❑ Plans Submitted Yes No FIXTURES v s[s>aw� HdlSFMIVI ZB EL" 3MHIM 4IH NDM 6M E OCR 7IH HDM SIH)N m (Pent or type) Check one: Certificate Installing Company Name_/A 122 d ,,-rl P4/ ❑ � Corp. Address _ �� ! �� `� ,�n,a c 1;-�„j ;,�ff ; y/❑ Partner. Business Telephone / a 3 ���9 9/a O e'c k r e``i` Ad"S/ Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11 Bond Insurance Waiver: L the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach tate Plumb' and Chapter 1 of the General Laws. By: rcens Title Type of Plumbing License 9 �,10 City/ rcense umaor Master Journeyman Q/ APPROVED(OFFICE U$E ONLY 1_I t w� The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston; MA 02111 www mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Appficant Information Please Print Le�bly r/ Name(Business/Organization/lndividual): ��IDm4� Address:�� City/State/Zip-/Arn,QS f ,! () // 6J R cj l Phone#: t�0,7_ 3.)g! —V.-20o Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required): ployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.VeI am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers comp. insurance 5. 9. ❑Building addition ' p ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.❑ Other +Any applicant that checks box#1 must also fill out the section`below showing their workers"compensation policy information. 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 workers'compensation 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 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 cern r tder the p and penalties of perjury that the information provided above is true and correct Si a `�14e Date! 7 Phone#: EEJL only. Do not write in this area, to be completed by city or town officiaL n Permit/License# hority(circle one):Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectorson: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants A 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 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 pernait 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 applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-72.7-7749 mmm,.mass.gov/dia Date.. OF ,ORT c 1 o� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SSACMUSEt This certifies that . . .171m . . . . . . . . . . . . . . . . . . . . .-. 7f? has permission for gas installation . . . . . . . . . . . . . . . . in the building's/of . . 17C .c. /. ./- —'/. . . . . . . . . . . . . . . . . . . . . . . . . at . . . P."Y. . . . . . . .. North Andover, Mass. Fee. . . . . Lic. No.. 1.5��:.F. . - a_.�- ..- .. . . . . . . i'�iINSPECTOR Check# ) 7 7 7098 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations V 7 /7'.0C 6e-aA,y !� Permit# Amount$ ���5 p c��1 P V Owner's Name New Renovation Replacement Plans Submitted ❑ a H x x ¢ a o a °o z U W w z 9 c x > w w w � � ¢ x x � w � w H w F x x w U U GW > W z d a a x z o z o x x o x w a 9 o U U a > SUB -BA SEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR STH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or tYp Check one: Certificate Installing Company ,/ Name_ 176M AS' /�g�'_/-14 Q;4 ��F-� Corp. Address VJ6,— n ),W) j T ❑ Pier /0 A/ d? PC-// business Ie ep one—6�p,?v ��� , ._!rn/ 02 IV Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked yes,please indicate the type coverage by checking the appropriate box. 13 Liability insurance policy 13 Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus tate Gas Code Chapter 14 f the General Laws. By: S' e of Licensed Plumber Or Gas Fitter Title Plumber & City/Town Gas Fitter License Number 13 Master APPROVED(OFFICE USE ONLY) meyman The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Uf 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A_pplicant Information Please Print Legibly Name(Business/Organization/Individual): �7—j7 a Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: ' Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. o workers' comp. insurance 5. 9. ❑Building addition [N p. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.F_1 I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.) 13.0 Other Any applicant that checks box#1 must also fir.out the section below showinb weir a ork '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 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: 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 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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: ' Date Phone#: [[1. fficial use only. Do not write in this area, to be completed by city or town official ity or Town: Permit/License# suing Authority(circle one): Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of.another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coinpliance 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." 1 Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to si=gn and date the affidavit. The affidavit should be returned to the city or town that the application for the pernaitor 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 applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investiegations 600 Washington Street Boston,MA 02111 Tel. # 617-727-49,00 ext 406 or 1-877-MASSAFE Revised5-26-OS Fax#617-727-7749 . wurv%mass-gov/dia N° 4 Date................'.................. r NORTH °f,�`'°;•'"° TOWN OF NORTH ANDOVER 3: �.,� ... ._,• of PERMIT FOR WIRING ,SSAcm This certifies that . has permission to perform ...: `... �'-`L ---�'- .....--0 .............. ............................................ wiring in the building of.....:.J.... z�.�r-. ` ,North Andover,Mass. at................ ....... .............:......... Fee........:.. e/ l 7 ELECTRICAL INSPECTOR 03/02/98 10:02 35.00 pplD WHITE: Applicant CANARY: Building Dept. PINK:Treasurer The Cor»r"onw+e�z>Iltla c, 0 Massachusetts ��tficn Use- r gar�^ DpParr►ne.nJ 0/P!Ibilr_ Permit NO. BOARD rr J BOARD OF FIRE PREVENTION REGULATIONS 5 27 cmn 12_:00 Qcru `� vancy 1t Fee Checked �J90 (leave blank) APPLICATION FOR PERiI4I'r TO PFRFOR'M Ae work ra M perlormwq In acoroenr•wdh the Meancnu»ee 61'_-urcal Cpye• ELECTRICAL yv IC (PLEASE RItIT IN INK OR TYPE ALL INFORMATION zrcurt t� F City or To. ofDate_�%�`-�-+� The underrianed applies for a permit to perf l.xatlan 14 Number) orm the electrical work described helow. To the Inspector of Wires: (:;tr net - Owner or en;int T /-�-- Owner's Ad fre. (f C' r _ Is this permit in conjuncticn with a buiY"ling Permit „ LJ Purpose of Buildingt�1 iit � (Ch".-k Appropriate Box) .LAG[• ��--__M1_Utility Authori2attor No. Existing Service �-_..Amps,--•--�------Volt; ----__-__-.------• U`+nrhead Undgrd New Service No. of Meters --__J�mps—.-----J--------__Volts Cverh�ad �1 -- Number of Fee Undgrd ❑ No. of Metnrs Feeders and Ampacft - -_ _- Location and Nat-,q of Proposed ElorWical Work._-- r l J r -- -- ----- No. of lighting Outlets ---- ~ -- --- ---�-1_ No. of Hct Tubs NO. of Lighting Fixtures -- -- -- INo• of Transformers -101A1 _ Swirr minq Pool Abovr3[�In �J _.___--_KVA� ---- Ornd. _ red Generators ~ Flo. of Receptacle Outlets - - �'-` KVA No. of Cil Burners No. of Emu g lighting No. of Switch Outlets - - -' Battery-n its No. of Gas_Burners "------------ No. of Ranges - _ ----------._ FIRE ALARMS COTAL - No. of Detection and fie• of Zenei of Air Conditioners -- -- -- _ TONS __ Initiating4 No- of pisGlOsals HEAT '-')pt.1L —IOTA-L - 0-.01 D-vices NO. of Pumps-- TUNS_ KW NO of Sounding Devices ---- fJo- of Dishwashers - - No- of Solt Containn-t Soace/Area Hearin DOIEctfon/SoOnding Devirns - No. of Dryers _ _._-----_qKbV -- -- _ Hea_tin DeviCe9 KW Municipal No. of Water Heaters �' - Lccal ❑ KW Ne of No, of - Connection UOlhef _--_ Ballasts L'A'N`1oltagv tlo of Hydro Ma sage Tuba _�ir,n_of Mot Totat IiPOTH (.t ----- ER have a c E COVERAGE: Pursuant to the requirements of Massichu.;ens General Laves I have a current Uability Insurance Policy tncluding Completed Ct valid proof of same to this office. YES c NO ❑ F erations Coverage or its Sub,tantial equival"rit. YF."i Cl NO p 1 haave eubrnilMd If you have chocked YES, please indicate the type Of coverage IW Checking the appropriate box. INSURANCE ❑l BOND ❑ p rHER C_I (Please Spr*:ify) Estimated Value of Electrical Work By_�-_-- - (Expiration Dntn) Work to Siart�- Signed under the penalties ofer u Inspection paa► "?qed:uest P ) ry: Rough_ Final 11"41 NAM ----- Li NO _ >`1 Address LIC. NO._ A7 f�• �� Z<n --------.6ua. tnl. flo.� O'VIIER'S INSURANCE WAIVER: I am aware that the Lice in!,, cl:,, not hay. f.t,"",chusetts General Laws, and that my signature on this ar•r"f„1tlon waive. AIL Tnl, flo. -_,_-- the insuranrn covert o or Its Sub",tantial grlr�ivahnt aslirnc{ by 9 thea rr quirernent. Owner- Agent (Rln,ee chert Cnn) i CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number—?-113Date �2-, 19f I THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF TH MASSACHUSE7TRTAT E BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED T ADDRES45 S '° s i _ • Cows • o t♦ Building Inspector r o. s f j 7L Xe. F own of over No. 1. •• - s LAKE d©ver, 1 Mass. � 19 4. " + w Q'94_COCMICMEWIC K >.`s"�• p'4 T E O AT �J v BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..................................I.....:..r..................................................................................................................... i Foundation ` i as permission to erect........................................ buildings an ............................,....................................................... Rough-, to be occupied as.,------- s ' himney ; 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 Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough - a `�Q PEREXP�J I V 6 MONTHS a 1V111 ELECTRICAJ, INSP.ECTOR UNLESS CONSTRUCTION STARTS R 4h�� '. f y ....................................................... .. ...... ce .......... ...... .. ....... BUILDING INSPECTOR J �/ i final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Rough 6 No Lathing or Dry Wall To Be Done ina v'`'im''`" _ Until Inspected and Approved by the Building Inspector. DEPARTMENT r � I �llrnei Street No. F � PERMIT ? APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAr-aJO. LOT NO. i:3 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE I SUB DIV. LOT NO. : I i LOCATION PURPOSE OF BUILDING `T / r 1j�iL(1rI�A..Ys L-13h9-e_ r}7�.4�i!.7't�f�(. �'S nx- r� ✓I OWNER'S NAME INO. OF STORIESa SIZE OWNER'S ADDRESS �,oy� �� CTK1^�J�U a '� BASEMENT OR SLAB y? 1 ARCHITECT'S NAMEa , SIZE OF FLOOR TIMBERSdJ C�l�1ST _l„r j T 2ND �x �b 3RD BUILDER'S NAME r{/•�' ^ ^p � /F., I�r�Jl/YVC�1' SPAN 1 I cJ DISTANCE TO NEAREST BUILDINd DIMENSIONS OF SILLS /y( DISTANCE FROM STREET �/\ "' POSTS 3- DISTANCE FROM LOT LINES-SIDES i/ REAR GIRDERS /c/ Cl`/'1 AREA OF LOT �j� �..y., FRONTAGE HEIGHT OF FOUNDATION ("1///` THICKNESS %o / IS BUILDING NEW o` ��•r SIZE OF FOOTING "7 /0 X ;,-. /> IS BUILDING ADDITION k� MATERIAL OF CHIMNEY 4 IS BUILDING ALTERATION 't IS BUILDING ON SOLID OR FILLED LAND I}/ WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Yom' IS BUILDING CONNECTED TO TOWN WATER 09-3 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER � y-•� IS BUILDING CONNECTED TO NATURAL GAS LIN g' PROPERTY INFORMATION INSTRUCTIONS LAND COST CJ �}- SEE BOTH SIDES EST. BLDG. CO8 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FTr PAGE 2 FILL OUT SECTIONS 1 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED qA UA BUILDING INSPKCTOR SIGNATURE OF OWNER OR AdYHORIZED AA19ENT FEE C® OWNER TEL.kC* PERMIT GRANTED ^ J� CONTR.TEL.# �"t0 Qd0�-- k2rLi 19 �J �' 236 2 CONTR.LIC.# ( O H.I.C.N l 0 ��� i T BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYStORIES THIS SECTION MUSTSHOW`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 _ B 1 2 J _ ' CONCRETE BIL K. PINE ✓ ✓ ^ BRICK OR STONE HARDW D __ _ PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA FIN. ATTIC AREA _O B M'T FIRE PLACES N _7� HEAD ROOM MODERN KITCHEN 4 WAILS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING COMMCN — VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 6 FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ TUPERIOR ADEQUATE 19 NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED •WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 6 GRAVEL STALL SHOWER - - - ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING i l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR t ✓+1 c L..�.JU .�r.J WOOD RAFTERS _ AIR CONDITIONING (•`;,�tt RADIANT H'T'G UNIT HEATERS -- s"'�`�--� 7 NO. OF ROOMS GAS iii'.•�"--�E�� OIL B'M'T 2nd S _ ELECTRIC 1st 13rd I NO HEATING PERMIT NO. Y <> APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4,40. LOT NO. a 2 RECORD OF OWNERSHIP ;DATE (BOOK ;PAGE ZONE I SUB DIV. LOT NO. r _ LOCATION I''' I _ PURPOSE OF BUILDING I OWNER'S NAME - NO. OF STORIES SIZE — -- / OWNER'S ADDRESS - - - BASEMENT OR SLAB ARCHITECT'S NAME - '- SIZE OF FLOOR TIMBERS IST — — 2ND — _ 3RD BUILDER'S NAME �' + SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET - '" "" POSTS = -� DISTANCE FROM LOT LINES — SIDES REAR "" "" GIRDERS AREA OF LOT - FRONTAGE HEIGHT OF FOUNDATION THICKNESS - IS BUILDING NEW SIZE OF FOOTING % - IS BUILDING ADDITION - MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER - BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE ' INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST . - SEE 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 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED C FI tU1LDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT FIE E ? =L� OWNER TEL.k PERMIT GRANTED CONTR.TEL. - �Z BLDG.PERMIT FEE .�..�. LESS EFDA FEE ---■ CONTR.LIC.# ! ' DUE FRAME PERMIT= H.I.C.# '' i PERJIIT NO._ APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4J0. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE I SUB DIV. LOT NO. r - r LOCATION �` .-.. F _ _ PURPOSE OF BUILDING ' OWNER'S NAME i NO. OF STORIES SIZE OWNER'S ADDRESS - BASEMENT OR SLAB ARCHITECT'S NAME -1 SIZE OF FLOOR TIMBERS IST - 2ND - - 3RD BUILDER'S NAME , SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GIRDERS ' AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION - THICKNESS i IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND - WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY ,, IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST - SEE 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 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR i DATE FILED 4 i BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE 1 OWNER TEL.#' PERMIT GRANTED CONTR.TEL.# BLDG.PERMIT FEE - -igCONTR.LIC.# - LESS FSA FEE • DUE FRAME PERMIT S H.I.C.a ! - t4OR T Town of over L * . _ �; b dower, Mass., C COCHICHEWICK tY'�• '9S .4'r E D I`pP�y � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT........................................... .:.......... 4.......C.6.?,p.................... BUILDING INSPECTOR Foundation has permission to erect.................(...................... buildings on .....4...?.......,�.`"1.. f .. ......... /._.`+V.�.... Rough to be occupied as................................................" ./.zy.c'. ...........lz�4 '1.1.. ..l.................................................. Chimney provided that the person accepting this permit shall in every respect conform to the teFms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS � UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR TS _ Rough L Service ,.:.. .`. ..... .j.. ........................................ ... . . r BUIL ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. i FORM U - VERIFICATION 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: 1J�`f -367t/ Phone i LOCATION: Assessor's Map Number Parcel Subdivision ?1K-A01-U10-VW i-6 �7'� Lot(s) 13 Street ISP St. Number ************************Official Use Only************************ RECO ATI SAGENTS: Date Approved Conservation AdAnistrator Date Rejected Comments Zft Date Approved own PDate Rejected Comments Date Approved Food Inspe tor-Health Date Rejected Septic Inspector-Health Date ApprovedDate Rejected Comments I Public Works - sewer/water connections - driveway permitiL � 7 �EQd����, ibq�c�1 wi:tEc� S�lio.�c fTTt'roeS -� 4 Fire Department �.�7�.oL f6�K�i�.L�.�F�rr An Received by Building Inspector Date ✓ �� Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.5 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit(below) Address of Property for Permit(below) Map and Parcel : Puroose of plication (check below) Pholte_Number,of,Applicant: _Single Family _Two Family 1 the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration,or reconstruction of a dwelling in exnstence s of the effective date of this by-law, provided that no additional residential unit is created. The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals,where all of the conditions of 8.7.6.c are met and/or represents Dwelling urits for senior residents,where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section"senior'shall mean persons over the age of 55. • This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density, (buildable lots), below the density,(buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply,whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. Sign ure 6f Owner or Au d Agent wh signed the Attached Building Permit Date This form must be atta ed o the Build' g Permit upon application for such permit.