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Miscellaneous - 495 REA STREET 4/30/2018
495 REA STREET 210/038.0-0093-0000.0 i Date.. .... ..�.. .............. OF r10RTly, TOWN OF NORTH ANDOVER * * PERMIT FOR WIRING s`SACHUS� This certifies that ...Q ..!m 'N .P....`•.``.. has permission to perform ..... `�� �"� M `^+''�`. wiring in the building of... ..�--!��!'e-- ... .............................................................................................. at ....... ...[ ...... ("- 1 ......... rth Andover,Mass. Fee. " ...........Lic. No.A�Z, :/ . ................................................................................. v ELECTRICAL INSPECTOR Check# Q Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. ' ")se\Q BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked r` (Please add zip codes & electrician's cell#; Rev" pan (leave blank) contract# & bid permit#if applicable.) 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: _711.11i City or Town of: 1yetjp /.w .)V-i 4 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) 4lgS' 415.4 Owner or Tenant J'� CEJ Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No [9'- (Check Appropriate Box) Purpose of Building 9(,S/- Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 041/.4 06 L.Ur,-i iv C-/;2 44-,l I,> W1 71; ,124/4 Lir, C s r✓/`o-e-77 yr✓ Sy t T):A 2ti S 7>4 L,c- A,--CZ Com letion(?/'the/blloiring table nztrn be waii,ed bi,the Ins)ector o/"N•lres. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans No. o Total Transformers KVA No, of Luminaire Outlets No.of Hot Tubs Generators KVA No.of LuminairesSwimming Pool Above ❑ In- ❑ o. o Emergency Lighting rad. rad. Battery Units No. of Receptacle Outlets C No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo.of Gas Burners No. o Detection and ' InitiatingDevices No. of Ranges No.of Air Cond. Total No. of Alerting Devices Tons g No. of Waste Disposers Heat Pump Number Tons KW No. oSelf-Contained Totals: " ' *-* " " '"" """""""'""" Detection/Allertin2 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 No. o Water KW No.o No.o Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eq uivalent OTHER: 3i fj(�D Attach additional detail i/'desired, or as required by the Inspector q/,N'ires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: `2 J7/15 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no pennit 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 X❑ (Specify:) General Liability 12/31/15 I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Boissonneault Electric Corp. LIC. NO.: 11823A Licensee: /tti/Le,n,.,,/6v,jJ Signature LIC. NO.: „2 Y/-Po (I/applicable, enter "evempt..in the license number line.) Bus.Tel. No.: (978)454-0383 Address: 36 Chuck Drive-Dracut, MA 01826 Alt. Tel. No.:_1978)458-9977 *Security System Contractor License required for this work; ifapplicable, enter the license number here: 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(clieck one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Department ol'IndustrialAccidents 4 ; I • Office of'Inveti•tigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 _.l-• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�lbly Name (Business/Organization/Indivi(lual): Boissonneault Electric Corp. Address: 36 Chuck Drive - P.O. Box 639 City/State/Zip: Dracut, MA 01826 Phone #: 978-454-0383 Are you an employer? Check the appropriate box: — 4. I am a general Type of project (required): 1.OTam a employer with _� ❑ g' - �al 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 rile attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have 8. E] Demolition working lot-me in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance.t 9. ❑ Building addition required] 5. ❑ We are a corporation and its 10.[_ectrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of"exemption per MGL c. 152, 12.0 Roof repairs insurance required.) 1' ,��I(4), and we have no employees. INo workers' 13•❑ comp. insurance required. Any applicant that cheeksbox ill ntttst also till out the section below showing their workers'compinsalion policy inhumation. t 11omeow11ets who suhmit(his affidavit indicaling(hcy are doing all work and then hire outside contrac(ors muss suhmil a new a ffidavil indicating such. 4'01111'actots that check(his I)OX must imached an additional sheet showing the name of the sub-conUaclors and state whether or not Ihosc cnti(ies have emploveas. If the sub-contractors have employees,they nutsf provide tlieir workors'comp.policy number. I am an employer that is providing workers'compensation insurance for my entplt�yees. Below is the policy and job site information. Insurance Company Name: Utica National Insurance Group ---- -- ....---.... -------—----------- Policy#or Self-ins. Lic. #:4386559 _ Expiration Date: 1/1/16 ---- ----_..__---------------_-.__-- ------------ Job Site Address:�1R SS ��i/,f S �ylf/�1— Cit /State/Zi Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration (late). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to (he il"POSltfon of criniiflal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the 1.61-111 ofa STOP WORK ORDER and a tine Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Officc of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the inforntution provided above is true and correct. Si >nature_. _._.. ------ Date: Phone#: 978-4540383 [FOjInly. Do not write in this urea,to be contpleterl ley city or tunvt official.: Permit/License # lcial ority (circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector 6.Other Contact Person: Phone#: .:..TS:. RIC1ANS , ISSUES THE_.:FOLLOWING LICENSE AS A RECISTEi` D MASTER ELECTRICIAN BO.I:SSONEAULT ELECTRIC CORP NdAmAND _D 8Ct1SSONNEAULT PQ BOX 639 6ii'ACUT MA 01826-o639 32609 ro " MM W.ALTH OF M ; UShTTS • • • - • • . ANS ISSUES THE FOLLOW CNG ::LICEN SE AS A ;REG JOURNEYMAN ELECTRICIAN . NORMAND D BOISSONNEAULT PO Box 639 DRACUT MA 01826-0639 \\` 24694 E 07/31/.16 326101 awl Zak f 4 MERR ENGINEERING I ERV CES INC. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 ATE JOB NO. (978) 475-3555 ATTENTION Fax (978) 475-1448 TO RE: J� � rL� c•� ��G�`t, _ WE ARE SENDING YOU ❑ Attached '❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION v ,Sd c- PI THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval oour use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED��_ If enclosures are not as noted,kindly notify us at once. Location -�z ?" No. Date 2, a?.-- NORTH TOWN OF NORTH ANDOVER a Certificate of Occupancy $ s Building/Frame Permit Fee $ sACMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 7 �� p r 1 5 7 L `+ 6/ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT r APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING. WAR NoM BUILDING PERMIT NUMBER: 3 DAT` ISSUED: SIGNXTURE: ✓` C - �' Building Commissioner/Ifor of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0 qq. WX- ST 03 a, oo F 3 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft _ 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Rpqttired Provide ReWired Provided Rapired Provided 1.7 Water Supply M G I..c.40. 34) 1.s. Flood Zone Info tion: 1.8 Sowerage Dupossl System: Public ❑ private zwe Outside Flood Zw ' Municipal 0 On Site Disposal System SECTION 2-PROPERTY OWNERS11 P/AUTHORIZED AGENT V rn 2.1 Owner of Record n21 t�ry 'F /V' " Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: - l Name Print Address for Service: O z Signature Telephone Mm SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensca'aConstruction Supervisor: C s D 6 2 License Number Ado7Zdress 7VJ2 eV -12 A676r V 6 F/2oa z 3 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 v Company Name 22 / ` / Registration Number Address r Expiration Date Si nature Tel hone SECTION 4,WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes..... 1. No.......0 —� SECTION 5 Description of Proposed Work(check all.a licable New Construction 0 Existing 13uilding ❑ Repair(s) ❑ Alterations(s) 'Addition a. Accessory Bldg. ❑ Demolition 0 Other ❑ Specify-� Brief Description of Proposed Work: IDX 2 ��- '�,S (� 26 ©�L 3 b6 n 5a 0 SECTION 6-ESTIMATED CONSTRUCTION COSTS ��5 Item Estimated Cost(Dollar)to be S� Completed by permit anolicant a ala 1. Buildin gD� (a) Building Permit Fee Multi tier 2 Electrical (b) Estimated Total Cost of Construction �j oZ 0 3 Plumbing d O B Building Permit fee(a)x(b) 4 Mechanical AC 5 Fire Protection 4a 6 Total 1+2+3+4+5 3 00 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,_ �71��f114Y � uk,Y as Owner/Authorized Agent of subject property Hereby authorize l7A�j ��!�(�/>¢ �r K to act on My behalf,in all matters relative to work authorized by this/building permit application. Signature of Owner Date i SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, i:)1h,)) F �G (T/i�cJ L 7 'C as OwnAuthorized A t of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print e 12, o/Z Si ature of Owner/Agent Date' NO. OF STORIES SIZE Z (Mc Z? f$)C /� 2 S i ti Rem r BASEMENT OR SLAB S A fj SIZE OF FLOOR TLMBERS /-5"r J`pi g j" I 2 3 SPAN / 1 DIMENSIONS OF SILLS YX 6 DEMENSIONS OF POSTS 41x DIMENSIONS OF GIRDERS , HEIGHT OF FOUNDATION Z , (�' THICKNESS IC) SIZE OF FOOTING X r p, MATERIAL,OF CBEVINNEY IS BUILDING ON SOLID OR FILLED LAND 5 o l i IS BUILDING CONNECTED TO NATURAL GAS LINE f , 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. *****************************APPLIC^ANT FILLS OUT THIS SECTION*********************** APPLICANT•DAA i D (Kc 61,+j PHONE 9�GY S G 34 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) STREET R C/4 S-F Iy- IQnJcl ST. NUMBER.' ************************************OFFICIAL USE ONLY***************,*** ** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION AD N ISTRATOR DATE APPROVED DATE REJECTED COMMENTS_Ajb LvidlakigS G✓ Qj4 / TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS OOD INSPECTOR-HEALTH,` DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED Q DATE REJECTED4;�..,. COMMENT PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm The Commonwealth of Massachusetts • State Board of Building Regulations and TOWN OF NORTH ANDOVER Standards BUILDING DEPARTMENT Massachusetts State Building code 780 CMR APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OF OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date MA- ti X,f) 2,00 Z, SECTION I-SITE INFORMATION 1.1 Property Addres: 1.2 Assessors Map and Parcel Number:T Map Number 0'313 Parcel Nu be 3 1.3 Zoning Information: 1.4 Property Dimensions:n io Y Z/ �/ !k f �4 t22 ��5t (� Lot Area(sq) Frontage(ft) ZoningDistrict ro oeU �] 1.6 Building Setback ft. Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 1 ;Z9 107 Water Supply 9M.G.L.C.40.4 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public P Private O Zone O Outside Flood Zone Q Municipal O On Site Disposal System )4 2.1 Owner of Record ATP- c-2o i•,!E 495 PEA ST NOR— Name(Print)t"L Address: Signature / Telephone 2.2 Authorized Agent: Z?/+L.�r D me G-1 qt Z t 7VI2NG Name rint Address G Signature Telephone SECTION 3 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE 3.1 Licensed Construction Supervisor: Not Applicable Q Licensed Construction Supervisor: License Number -c • C s 0 ,.-( G -7 - Address 2-( ��Zt�Cl2 �r Expiration Date 2Sign �iel i 1(✓�l�S- s, 12- Signature ature Telephone 3.2 Registered Home Improvement Contactor: Not Applicable Q tDA-SSA lA-V t,W Company Name Registration Number Address Expiration Dates Z ( TUi2`v�- Dr Nor1� �1 Z2 03 Signature Telephone 97t-(VG 5-� 3c Revised 1997 JMC r .� a•;: y d at ^xrryjvI4 .- - ,i.- �5+^yM ,4appq,,-,Sii , . p F r 4; l 'if 'Y11. i . - >. �' r, , �tJ. �.t ♦ i M,:Ir r, n r .VY K. �°'' r 4 {ti< - �,..,rr... �, y�' S.,r y,�,"., t F Mn s} �, r x i nit • .�` ryJ.y T �.1 i, _ _ +t.•w.'�-r .�..r'"'...r.w� Vii} . 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' ., : - ''f-'' ' �' . t r r r s-y A.�CtiY d t i k J t�.+, - a i. g t -.j J c h f .i.;`\ , - ^t r `t 4 .fir -irq I ai 1 \ j N t h 1. t L r 2� F • i� F a., /� 'a - u tez�hy certify fiat t6 buildLx; .. 4 T V. /'- ,� fSn:: ha& property is IQcated as shown ,fln 11 L1 I :Flar. and complies' with. the �ttildir11 1. and r J �y r. ti coni n` *Sa fs of the Town a `I,� Ando . F'�iJe in ..! 'f'.v.,-,L /4WD a`t?� r} . j �2 r ^F 4 `. , �; k .s 1 �, r t. 'RARY. S E. GYR11 . ,;J rr l tr1`. 'If i- Y y ^t my �rL4. ;+i`FPE;Y E,.. : ,aWR :cam, flaag y @ Y y 'i •J t.. e� L a % ¢, i r Aii ,. r ! moi. 1J .of J . I Ih y4�~��Y� �� R rid; I .. - - ' North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) �GliucY Signature of PdAit Applicant 2 2/! zuy Z. Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: y?.S %26-14 577 Citv l Jt),,6-74 kld,ofn 04�-5 Phone am a homeowner performing all work myself. I.am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone#• Insurance Co. Policy# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature aA4AJ� Date 3L?-YLO -z-- Print Print nam dav i D Mc(r/*Vr IIx, Phone# 2 7Fl-(-4(1-1-6 Official 1- Official use only do not write in this area to be completed by city or town official' ❑ Building Dept E]Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION ' t .. l�� a//7� �dlYl/hL�I2UlC�L �V4G4UXl��QQUO tI BOARD.OF BUILDING REGULATIONS 1'. License CONSTRUCTION SUPERVISOR Number: 046728- Bi d--�'F-10871950 ' Ei� 002 Tr.no: 5229 I 4 es d! DAVIQ G NfCGLAC1Ftl %° _ 21 TURNER DR N READING, FAA 01864 Administrator 4 . Board of Building Regulations and Standards ©ne.Ashburton Pla :n Room 1301 lug Boston, Maw c S02108 Home Improv - ctor Registration _ Registration: 119101 Type:. Individual Expiration_; 0512212003, DAVID G MCGLAUFLIN DAVID MCGLAUFLIN 21 TURNER DR f _ O READING, MA 0'1864 - f Update Address and return card-Mark reason for change d Standards '`'' License or registration valid for ihdividul use only Board of Building Reputations an v 1 t before the.eipiration date. If found return ds HOME IM_ 5RVVEMENT CONTRACTOR. ;. Board o.1'^3uilding Regulations and Standards IRE00Eon y3101 One Ashburton Place Rm 1301 i t, Boston, .(a.0210$ _tPaB. 2I2003'i r4 DAVID G MCGLAU 1 �%f DAVID MCGLAUFLkt M 21 TURNER4R NO READING, MA 01864 - - - - a For RC-A S ` i ol ell i i" i - 2 rel vtem �' - ,17 ✓1 �L�nJ e �a '� r' � It 1 ` 1Udr ice, iZa-�dr�ry /1. IJ fS cy v rz.L jZ. �► mr l e �� lie 4 j s CZ -- i wi s`►�`�N o„9l s6 w-a-t. _ ?l, • � _._.__��dos---- - . ------- -- o � yAth 0 ir ;'1) Kik ,�� of 14 I 0-4 n 1 ✓dJ zp?Nt1r?L 9ti f 5 al7"t1�NoJ G n1S f e I I ,7.o"l1 v A ' Town of North Andover tk°Rrh 04 Office of the Health Department Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 ac,�yse Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 April 18,2002 Adrian F. Crowe 495 Rea Street North Andover, MA 01845 Re: Application for an addition Dear Adrian: Your application for an addition at 495 Rea Street has been reviewed by the Health Department. The application was denied on April 16,2002 for the following reasons: I. X Missing information 2. X Passing Title 5 inspection of septic system may be required 3. ❑ Location of structure not acceptable To address the problem(s): If#1 is checked, please supply: a. Floor plan of the existing house and the existing house with the proposed addition b. Certified plot plan showing house,septic system and proposed project in scale If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If#3 is checked: a. IRelocate the project Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Brian J. LaGrasse Health Inspector Cc: Building Department David McGlauflin,21 Turner Dr.,North Reading,MA 01864 File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 NORTFI OV TM of 4Andover 0 03 OR AIL o _ A o dover, Mass., COCHICHEWICK �t A0RA7ED P' -`� S BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D ��OW � BUILDING INSPECTOR THIS CERTIFIES THAT...,� ........................................................................... .....;t..................................... .......................... Foundation Q � has permission to erect...1..1>,.00! �..6.............. buildings on ....4..I... °:.`... .`�.a.........b......0........................ Rough r ♦ Chimney e k y tobe occupied as..l'�.r.�,� .................................................�...................�.........................�...........�.�.................... 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-7�-3 elating to the;7zado ection, Alteration and Construction of Buildings in the Town of North Andover. 3 ,�. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIO T TS ELECTRICAL INSPECTOR CRough .... .. .. .. . 0�il . Service G 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. SEE REVERSE SIDE i HAUL LIC # 777 $100 1996 STEWART'S SEPTIC TANK SERVICE .INST LIC # 659 $200 1996 47 RAILROAD STREET BRADFORD, MA 01835 508-372-7471 May 3, 1996 fzn NO ANDOVER BOH f r15 6 4S "l TOWN HALL ANNEX �a�,t`=';,'�. �• ,_ . 120 MAIN STREET 'y ' NO ANDOVER, MA 01845 9 rFb PH# 508-682-6483 --~ 508-688-9540 ** FAX 508-688-9556 Dear SIRS: The following is a list of properties that we purged in your town. In accordance with TITLE V regulations, we are complying by sending you the following on a monthly basis, if need be. If we didn't pump, you will not be notified. PUMP DATE ADDRESS GALLONS 04-01-96 197 ABBOTT STREET 1,500 105 WINTERGREEN DRIVE 11000 04-02-96 A 42 OLYMPIC LANE 11000 04-04-96 A 71 PENNI LANE 11000 04-06-.96 492 SHARPNER'S POND ROAD 11000 A 39 HAYMEADOW ROAD 1,500 04-08-96 498 WINTER STREET 11000 187 SOUTH BRADFORD 11000 04-09-96 A 495 REA STREET 11000 04-10-96 A 706 FOSTER STREEET 11000 04-11-96 A 83 CAMPBELL ROAD 11000 04-11-96 A 43 CHRISTIAN LANE(?) 1,500 04-12-96 7 HAYMEADOW ROAD 11000 1577 SALEM STREET 11000 04-13-96 278 BARKER STREET 1,000 HEAVY 04-16-96 A 30 BREN'T'WOOD CIRCLE 11000 04-17-96 A 27 COACHMAN'S LANE 11000 04-18-96 369 HIGH PLAIN ROAD 11000 28 CEDAR LANE 11000 A 121 CAMPBELL ROAD 11000 04-19-96 A 160 BRIDALPATH LANE 2,200 04-20-96 A 200 RALEIGH TAVERN LANE 1,500 A 1 GARFIELD LANE 11800 M O Location No. Date NORTiy TOWN OF NORTH ANDOVER �e Certificate of Occupancy $ Building/Frame Permit Fee $ S cMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 9 r 5 6 7 Building Inspect06, A j- TOWN M NORTH ANDOWR BUILDING DEPAR 'MENT, APPLICATION TO CONSTRU REP REAIOVA OR DEMOLISH"A ONE OR TWO FAM[Ly DWELLMG i i BUILDINGPERMIT NUMBER: DATE ISSUED:70 rn -c� -a�� SIGNATURE: X Bifflding Gonvllissioner r of-Buil Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: Assessrso , ...Map and Parcel Number 00-7 4 lUyf �(�u (/J Map Number Paroet Number 13,Zoning Information: 1.4 Property Dimmsiops Zonin Mquict Proposed Use Lot Area - " g & _ .. . 1.6 BUILDING SETBACKS ft Front Yard . Side Yazd Rear Yard R�qtlir _- ed Provide Required Provided .. Provided: 1.7 Wusr supply M G L C.40. Saj mood znae mmmixion. u._.sewerag,niapos l Systems .- — Public ❑ Pdvato ❑ zone Oatside Flood Zone 0Muaiapil ❑ _,. .., : .. 0u Sit.I)aposat System D, SECTION 2-PROPERTY OWNERSffiP/AUTHORIZED AGENT ' 2.1 Owner of Record - m Name(Print) Address for Service: Signature Telephone _...- 2.2 Owner of Record: Name Print Address for Service: z Signature Tef hone rn t SECTION 3-CONSTRUCTION SERVICES �0 3.1 Licensed Construction Supervisor:-^ Not Applicable 0 �syrL -Licensed Construction Supervisor. V/ �-7Z (j O ; A of incense Nnmber I S� (, j1_— Ad 2 zo 0;. . zicSignature&d2 Telephone Exptrah° Date 3.2 Registered Home Improvement Contractor, g Not Applicable 0 Companyl4ame 7 , Registration Number 21 Z�fzJ(, �. (72 i 11 ,e /'(�. r M cess: Vi D 2� � d Z Signature Telephone G) SECTION 4 WORKERS COMPENSATION,(M.G.I,.C.152 § 25c(6) Workers Compensation Insurance affidavit inust-U complated'and submitted:with this applicatidn. Failure to provide this affidavit will result in the denial of the issuance of the building Signed athdamt Attached Yes......11 No......:D SECTIONS Description of Proposed Wdirk(cheek arta ' ble New Construction ❑ ,Existing Building 0 `. Repair(s). Alterations(s)` _❑. Addition ❑. .... Accessory Bldg. (I Demolition 0 Other ❑ Specify Brief Description of Proposed Work kv use SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be tr? Completed bi paniit licantI W— Mmm.I—Mm'- 1. Building 4/ /�f� (a) Building Pgmv t Fee.. V(J - Multilier - 2 Electrical (b) Estimated Total Cost of.,. Construction 3 .Plumb" Building Pernrit fee(a)x(u) 4 Mechanical(HVAC)- 5 . . AC..5 ..F.ireProtecficm 6 -Total 1+2+3+4+5 Check Number SECTION 7a-0WNER AUTHORIMTION TO BE COMPLETED WHEN . OWNERS AGENT.OR.COO�NTRACTOR APPLIES FOR BUILDING PERMIT U L t [D W as Owner/Authorized Agent of subject property Hereby authorize ��.1 /�/C(s 11�y to act on My beha ,in all matters tivve p work authorized by this building permit application Sr . hire of Over Datee.mss/t7li SECTION 7b 2WNEPJAUTHOR14-D AGENT DECLARATION I' as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/gent Date. NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR.TIMBERS iST 2ND 3 RD SPAN i . DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING K MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND. IS BUILDING CONNECTED TO NATURAL,GAS LINE i " I , . y M1 i - _} -- . ' n" � ✓fie-oPo�r�.no�zUfe� o�sGl«a�ac�Uaelta +I _ BOARD OF BUILDING REGULATIONS l License CONSTRUCTION SUPERVISOR :i . ` Number _ 046728. t+ Birl ifid 2f08 1950 Q$72002 Tr.no: 5229 y Restricted DAVID G MCGLFCII �pf 21TURNER a N READING, 'RAA 01864 AdminEstrator OKI guatons an dards Board of Building Re = d Stan bort n Plate`.Room 130 . ©ne Ash o u,pBoston,, Ma ..:,; Betts 02108 ' - ,etor Registration Home Improv _ r Registration: 119101 M —t J Type;. Individual —, Expiration,:. 05/22/2003. DAVID G MCGLAUFLIN DAVID MCGLAUFLIN 21 TURNER DR NO READING, MA-01 . ��A4 �d rk reason for change Update Address and return card M sr iii �* : _ c y ___.� `V✓fie v�arn!neaieu�eald�'a�•�/,�%ulaa�c✓ze�ar'l�6 - z_ ` i Regulations and Standards '" License or registration valid for individul use only Board of Building-wilding Reg -_. before the expiration date. If found return to:' HOME IMt 12OVEMENT CONTRACTOR_: -. - _ _ Board(.r,3 uilding Regulations andStandards -- RE ,1g101 One Asi}liurton Place RM 1301 v §t2l2003 Boston,31a.02108. jn&dual tOF W DAVID G MCGLAUFF WAl- DAVID MCGL4UFL'1 21 TURNER-D - - NO READING,MA 01864 - North Andover Building Department i Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: b�t MA S) (Location of Facili ) La4t,(:���� Signature o6Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Y 4 216 Date...//..If.1 z:...... HORT11 TOWN OF NORTH ANDOVER 3 �.,� .. '• 0. H p PERMIT FOR WIRING ACMU This certifies that ........... .............%..........::.. ............................. has permission to perform wiring in the building of `— `"^... ' ................................................................................... / .. North Andover Mass. l Fee.Z ..t....... Lic.Na-1.. .�.��� ......I...... ................. ELECTRICAL INSPECTOR Check # �^ Official Use Only 774E COMMONWEALTH OF MA55ACNU5ETT5 Permit No. `/�l Depatwnt of Public Safety y BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy&Fee Checke / APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Daft the Inspector of Wires: Town of North Andover To The undersigned applies for a permit to perform the electrical work described below. -------- -�— Location(Street&Number Owner or Tenant_ — C ------------------------------------ Owner's Address__—_--C/k -- ---- ---------------------------------- Is this permit in conjunction with a building permit es No 1 (Check Appropriate Box) Purpose of Building_�!/V-L ` h --—-- --------_—__-------_—_--Utility Authorization ------ Existing Service.......r_ --6Amps-�d� —0)-`7 6 Voits ertread Un and d9 No.of Meters New Service .---_------Amps Overhead Un and - dg No.of Meters Number of Feeders and Location and Nature of Proposed Electrical Work-in,,i No.of L Total Outlets (INo.of Hot fuse No.of Transformers KVA Above In No.of Lighting Fixtures Swirrinting Pod amd Generators KVA No.of Emergency Lighting No.of R2Mtacles Outlets No.of Oil Burners Batlery Units No.of witch Outlets 0 No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranaes No ofAir Cond Tons Initiating Devices ___ _ Heat Total Total No.at Di sal No. Pumps Tons KW No.of Sounding Devices ------------ No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ------------- No.of Dryers Heating • Municipal • Other Devices KW Local Connection No.ig allo.d Law Voltage oZ ��-e6 No.of Water Heaters KW Si nss Bailases WiringZ D _S No.Hydra ManawTuds No.of Motors �+ Total HP �'��c� ti0 �7l oZ O OTHER: C c) r r'��.� /0 INSURANCE COVERAGE. Pursuant to the requiremern6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= No = If you have checked YES Please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER (Please Specify)—_—� -------------- --(Expiration Date) Estimated Value of Electrical Work$— _-C 0 ----------- Work to Start // -��� d Inspection Date Resquested__ Rough�!�� /------—Final G`1 ----- Signed under the Penalties of pe4ury: �- _ - FIRM NAME-------_-- _ fI— `-e c-v h.) LIC.NO. Licenseeature_ 5 _--_------- -- —Sign ---- -- —LIC.NO. a6 9 0 ----- �j y) n e �. - 6 S' CJ (/y/ ! TO w✓1 Bus.Tel No. - _ Address— -- AN Tel.No. ' �i'� c ---------- ----------- OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) ---------------- ----------- ___Telephone No._------------------PERMR FEE S_/!Ll--- - (Signature of Owner or Agent) - t ' 3d i 1. ' rl! . � r TO /�� � DATE TIME AM sem'�-.�(� �`�� PM P FROMJ� ��� PHONE c ( ) H OF l CELL( ) FAX ( ) N }-� E E �A —Y�G�cJ<< � Cv.ti - M s s E A G _ M e _ O E-MAILADDRESS SIGNED PHONED E] BACK CALL RNED SEE YOU AGAIN ALL WAS IN URGENT Date....lo-�3-..Q.3 t NORTH TOWN OF NORTH ANDOVER o PERMIT FOR WIRING SACHU This certifies that ...... . J� � ............................................................................. has permission to perform .............(` .�.0.d�.... .... .. ..... ................................................ wiring inthethe building of........ .r .a...................................................... ,�t........" ��, ......... `....�.........45..�............. .North Andover,, Mass. Pee Lic.No.° g.PG� . �O 'Mi(9C--1 - .................... ELECTRICAL INSACTOR Check # 4561) Official Use Only Permit No. /f'>•��jf��t/�GW�i1Z.0 /f� �ir[.,�'r�.�1Z[ift�'Gs�/ /.� Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 6 -19- 03 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number 7 Owner or Tenant Owner's Address Is this permit in conjunctionwithwith a building permit Yes;O No ❑ (Check Appropriate Box) Pulpose of Building SCJ mel/ r < Utility Authorization No. Existing Service /v a Amps 1"4�/ U Voits Overhead B-� Undgmd ❑ No.of Meters_] New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work )Ei3 'r'\ 2-Lh'a e I e e *:t 4-r jr/ / Total No.of Lighting Outlets (7 No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures 6 Swimming Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets S" No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di al No. Pumps Tons KW No.of Sounding.Devices No./of Self Contained No.of Dishwashers SpaceArea Heating KW Detedion/Sounding Devices ❑ Municipal ❑ Other No.of Dtyers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring %No.Hydro Massage Tuds No.of Motors Total HP 1OTHER: 0 INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES/No = have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Works /11 -)- a a �Work to Start T�� Inspection Date Resquested 4.-"V) C_y,�� Rough Final Signed under the Penalties of perjury: FIRM NAME LIC.NO. / (� Lkensee /✓)/ VX A2 A., ��h'1 s9G�-1.,� Signature - f /�ie��� �1 C t' LIC.NO.�eqC� 1 d� Bus.Tel No.,3�cJ - t �Y"J Yy k1 Address Aft Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE S (Signature of Owner or Agent) u w The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. • i Company name: Address City Phone#.- Insurance.Co. Policy# Company name: Address Cfir Phone I nsurance Co. Policy# Failure to secure coverage as required.under Section 25A or MGL 152 can lead table' andlor one yews'arpnso�t�veoILass�vil -OFU) tion of criminal A$IDpenaties d,a W,-fine alto 31,500:00 understated that a ��������� �afene�f�1110�D)�rtag►�9ainstmer ! copy of this statement may be forwarded to the office of Im estigations of the DIA for coverage verification. I do hereby certify wider the pains and penalties of perjury that the amymabon provided above is true and correct Signature Date Print name pboriQ# Official use only do not write in this area to be completed by city or town official' City or Town PenTA/Licensi El Check if immediate response is reguaEl Building Dept ed - ❑ Licensing Board ❑ Selectman's Office Contact person_ Phone# ❑ Health Department ❑ Other r� - Location l F No. Date MORTN TOWN OF NORTH ANDOVER O?O•t"•o ••,hO R O * ; , Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ I ' - Check #r 64 -,) "1 ,4 Building Inspector" The Commonwealth of Massachusetts State Board of Building Regulations and TOWN OF NORTH ANDOVER Standards BUILDING DEPARTMENT Massachusetts State Building code 780 CMR APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OF OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Building Permit Number: - 67 Date Issued: Signature: Buildin ommissioner/Ins ector of Buildings Date S—2 c — 0 3 SECTION 1-SITE INFORMATION 1.1 s�a STM 1.2 Assessors Map and ParcelNumber. Map Number -38 Parcel Number 93 1.3 Zoning Information 1.4 Property Dimensions: Lot Area(sq) Frontage(ft) Zoning District Proposed Use 1.6 Building Setback ft From Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 107 Water Supply 9M G.L.C.40.4 §54b 1.5. Flood Zone Information 1.8 Sewerage Disposal System: Public Q Private Zone n Outside Flood Zone a Municipal a On Site Disposal System 2.1 Owner of Record s rz A ) 57' Name(Print) A ss: / Signature Telephone 2.2 Authorized Agent: V/A,)•0 01c t A—*l sk- t TU 4.196 1�Q . mart Name(Print Address Signature V Telephone SECTION 3 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE 3.1 Licensed Construction Supervisor: Not Applicable Q Licensed Construction Supervisor: License Numb" 0 Address Expiration Date Signature r Telephone 3.2 Registered Home Improvement Contractor: Not Applicable Q Company Name_ Registration Number Address Expiration Date • • ; Signature Telephone Revised 1997 JMC SECTION 10b-OWNER/AUTHORIZED AGENT DECLARATION L e' �-t4-,J` l IV ,as Owner/A orized Age ereby declare that the statements and information on the foregoing application are true and accurate,to the best oo m�wled e and belief. Y g Signed under the pains and penalties of perjury. 1)1"' ACGEINAI,k Print Name "AOLO Signature of Own ent Date SECTION 11 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to 15�, Official Use Only be completed b permit applicant 1. Building (a) Building Permit Fee Multiplier 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee(a)x(b) 4. Mechanical(HVAC) 5. Fire Protection 6. Total= 1+2+3+4+5 Check Number May 14, 2.003 To: Fred Crowe 495 Rea St. North Andover, Mass. 1. Make living room and family room into one room a. Remove'center wall, install_beam- b, eamb. Posts at each end of beam c. Lally column with footing under post near stairs d. New blueboard with skim coat plaster on ceiling, patch plaster walls. e. New oak strip floor in living room f. Refinish family room floor g. Interior trim- oak colonial casing doors Oak baseboard Labor and Material:_$6500.00 2. Hallway: a. Remove wall separating hall and living room b. Replace raiing and spindles c. Replace oak treads and pine risers d. Refinish oak floor e. New blueboard with skim coat plaster on ceiling, patch plaster walls. _ f. Baseboard to match living room. Labor and Material......$6,700.00 Not included: Paint heat paint/stain permit G David McGlauflin 21 Turner Dr. North Reading Mass 01864 . GNttr+o�► SECTION 6-DESCRIPTION OF PROPOSED WORK check all applicable) New Construction J3 Existing Building Q Repairs Q Alterations Addition Q Accessory Bldg. Q Demolition Q Other Q Specify Brief Description of Proposed: /1�►O Y 1� WA llrKlCc� New W00 a.r 4 SECTION 7-USE GROUP AND CONSTRUCTION TYPE USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly A-1 A-2 A-3 IA Q A-4 A-5 1B Q B Business Q 2A Q E Educational Q 2B Q F Factory- Q F-1 F-2 2C - Q H High Hazard Q 3A Q I Institutional Q I-1 1-2 1-3 3B Q M MercantileQ Q R Residential R-1 R-2 �R-3-1 4 5A S Storage Q S-1 S-2 -f 5B Q U Utility Q Specify: M Mixed Use Q Specify: S Special Q Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS. ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index(780 CMR 34) Proposed Hazard Index(780 CMR 34) SECTION 8 -Building Height and Area BUILDING AREA Existing(if applicable) Proposed Number of Floors or stories include basement levels Floor Area per Floor(sf j Total Area(so Total Height(ft) SECTION 9-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No Q SECTION 10a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, AA"", ,As Owner of subject property hereby authorize L2 AJ L 0 WIC 10%, to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date revised bldg form/state JMC North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: r f3FT l 11v�' S YJDy'd oAs5 (Location of Facility) Signature of Pe it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit, Please Print Name:VAr,)i 1T C � If Location: City MA-33 Phone ?7;- Ce g 41-' 3C am a homeowner performing all wotYmyself. am a sole proprietor and have no one working in any capacity F-1 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance Co. Policv# Company name: Address City: Phone#' Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cernnder the pains and penalties of perjury that the information provided above is true and correct. 0 Signature r Date ' Print name VFTI?� Phone# ��"'� ` 3 g Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department Other FORM.WORKMAN'S COMPENSATION BOARD OF BUILDING REGULATIONS J - License: CONSTRUCTION SUPERVISOR Number CS 046728 Birthdate 12/08/1950 FFt `Expires.-12/08/2004 Tr.no: 6082 Re%ncted d DAVID G MCGLAUFLIN ?y 7 �/ �p 21 TURNER DR N READING, MA 01864x' = ' Administrator �- - 075 ' d Standards Board of Building Regu ations an . - :���A `_ One Ashburton Plat e Room 1301 sett Maw a 02108 Boston, s Home hnprove �.. ctor Registration Registration: 119101 -� hype;, Individual Expiration; 05/22/2003 DAVID G MCGLAUFLIN DAVID MCGLAUFLIN V 21, TURNER DR ' NO READING, MAO!864 - a, Update Address and return card.Mark reason for change T Board of Building Regulations Standards or registrat License' ion valid for ihdividul use only lug ,� before the.expiration date. If found return to:° HOME INtFRO�YEMENT CONTRACTOR;,._: Board of iuilding Regulations an Standards jRc rat►o> 119101 One Ashburton Place Rin 1301 tratq 512212003 Boston,i�:1a.02108 it . l t��� ; �! ��&Onldividual DAVID G MCGLAL %i DAVID MCGLAUFLIis� 21 NO READING,MA 01864 i r- 4 2l 'lUr1 hJ rt Q2 L.f oil Nyy .acv►1 I�or"R A4..djov eA �SS . I � - 9 r _ D C!� s Yz ., �._'•� _._Y.....�� •Je• �. � a�/� �� �� rte' f � .. - I � �—•�— t .. JAI _ t �MaU� tNAtl'. NCk! os1" 'Fii4v\� � UK 51 I I I i . 17/1 ` I ,,n,�J vua►c��rlrvl n1-Y .-Ls ba2r s 3, AVPTW tol e��i - joB 4 6 RCA _t`TP L�.Ef� t1. AAjQL)0SK Joseph Georgis, P.E. SHEET NO. OF 9 Taft Drive WINCHESTER, MA 01890 CALCULATED BY.J J G/ DATE. ,/9 L00_ � TEL & FAX (781) 729-4646 CHECKED BY �— DATE G[ ri, M SCALE T100I .j� 5CFA i 1 . , t ( , ! u8 i.. f : ! I t (J C 57-066 5r i o i I Q M oar.. i. '/� I.A/ Ll lel : zx.� . �(' r Jot L.T. - tb ! IL ! ss � M f o L!���5 i .. ...._:......_ .f..... :. .., .....4.._. ,..... i ,•i ; t , i {.,... . . .. _ _ f , i :j i , , ; ! { i I i ! irw 1 ( i ( i ! ! ' t. i SLi f i { I ! i ! is i , , ,f s J. /GAJ. Z- � � !, C i 4 i { Q� ! E 1 1 7-A ., ( _ i f ; : I I ''2 4x.18 145 _ I i I ! ; { ; } f >. vtroou,ta,�sn«u;�os,;v,eae; NORTH Town of Andover 0 No. C' 0 -Wo dover, Mass., -+v?o 00 1� COC NICHE-ICK 40 T E D P"? C� BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D THIS CERTIFIES THAT..,4 Whft la AA Of% 0 W 'to BUILDING INSPECTOR ..................................................................................................................................................... Foundation has permission to erect....O.e.a.m........ buildings on .........It I.r......./ do.4V.........4S."O.............. Rough ..... .... ....... to be occupied as......ro.......0 o4 a Re* "I .% .............................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes andB Laws relating to the ection, Alteration and Construction of Buildings in the Town of North Andover. J 7443 7 00/40 000p, PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ARTS ELECTRICAL INSPECTOR 000 Rough Service BUILDINGINSPECTOR 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. LSEE REVERSE SIDE NORTH Town of rAndover 7 No. 0'7# 7 0 LA E 0 dover, Mass., COCMICME-ICK RA'r E D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..A ��, 41 AA 0^0WVSV ....................................................................................................................................... ............ Foundation has permission to erect... LP,& PA ........................... buildings on ......... ......... .........a..................... Rough *Rdo at .% 10-1+0 Chimney to be occupied as......I ... e .........I.............................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and7B -Laws relating to the ection, Alteration and Construction of Buildings in the Town of North Andover. sow, PLUMBING INSPECTOR 3 - 913 7070 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ARTS ELECTRICAL INSPECTOR Rough .............. ............................... Service........................ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.