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Miscellaneous - 5 SKYVIEW TERRACE 4/30/2018
5 SKYVIEW TERRACE i 210/098.6-0085-0000.0 i t Claim # Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Rd. Suite B North Andover MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Inspector Town of North Andover Bldg. 20, Suite 2035 1600 Osgood St North Andover MA 01845 Re: Insured: James Pettorelli Property address: 5 Skyview Terrace North Andover, MA 01845 Policy #: 2608714 Loss of: 2016/09/13 File or Claim No. AD 2050 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000.00 or cause Mass._Gen._Laws,_Chapter_143,_Section_6 to be applicable. If any notice under Mass_Gen_Laws,_Ch._139_Sec._3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by first class mail. 09-15-16 Signature nd date 7/1/2016 Date:July 01,2016 20730 This is an e-permit.To learn more,scan this barcode orvisit northandoverma.viewpointcloud.com/#/records/20730 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 0 This certifies that Paul E Martin has permission for gas installation Reconnect cook top in the buildings of PETTORELLI.JAMES N. at 5 SKYVIEW TERRACE ,North Andover, Mass. Lic. No.2961 1/1 7/1/2016 i Date:July 01,2016 20731 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20731 16`' TOWN OF NORTH ANDOVER I � '5' PERMIT FOR PLUMBING This certifies that Paul E Martin has permission to perform Install kitchen sink plumbing in the buildings of PETTORELLI.JAMES N. at 5 SKYVIEW TERRACE . North Andover, Mass. Lic. No.2961 1/1 6/28/2016 Date: June 28, 2016 20728 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20728 ' TOWN OF NORTH ANDOVER PERMIT FOR WIRING D This certifies that Lee F Burris has permission to perform Wiring for kitchen remodel, new circuits for wall oven, steamer unit, reworking outlets, switches, lig_htina for new kitchen layout. Retrofit wiring for new office receptacles, switches, cabinet lighting. Retrofit wiring for new dining room, living room recessed lighting fixtures. wiring in the buildings of PETTORELLI. JAMES N. at 5 SKYVIEW TERRACE , North Andover, Mass. Lic. No. 887 1/1 NEW ENGLAND CLAIMS SERVICE, INC. Incorporated 1985 ❑ Reply Toa, ., Reply To Mansfield, MA 02048 131 Dodge Street, Suite 6 P.O. Box 345 -4, Beverly, MA 01915 4(i{(l 1MH7 TEL. {508} 337-8058 TEL.axe ,� TEL. {978}927-3000 FAX{508}339-5835 r7rx,r¢ r FAX{978}927-3002 wrandall@newenglandclaims.com Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec 3B To: Building Commissioner or Inspector of Buildings City Hall North Andover, MA 01845 RE: Insured: James &Kerna Pettorelli Property Address: 5 Skyview Terrace,North Andover, MA 01845 Cause of Loss/Date: Water Damage Loss of 11/25/2013 File or Claim No: BOS051875 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL L AWS,,CHAPTER. 1.39, SECTION 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Section 3B. No insurer shall pay any claims(1) covering the loss, damage, or destruction to a building or other structure, amounting to one thousand dollars or more, or(2) covering any loss, damage or destruction of any amount,which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code,to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to J section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section,.or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Very Truly Yours Mark Randall Adjuster m.randallnecs@comcast.net {978} 223-7332 cell Date . . .7:. • TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . /!'(l� has permission to perform . . . . . .. . . . . . . . . . . . . . . . . . QQ wiring in the building of . . . . . . .( .�"T7`'b."Oe Lt t.i . . . . . . . . . . . . . . . . . . . at . .�. .S!� .Vle-W . .TIC . . . . . . . . . . . .ANNh Andover, ss. Fee . .�3 .-�. . Lic. No. ,4JS-711. . . . . .ELESP CTOR Check# 7,9 2 O 10938 C.ommonwea[th o�IY/a�bachu�e Official�7Use Only c� Permit No. (! - eUeparEmerct o��ire�erviceb BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked � [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 EV INK OR TYPE ALL INFORMATION) Date: Z'v\U q a 0 l a City or Town of: No1ZTF1 I+N t)®V6'-2 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) ::->\C \� V t EW i�-/Z--`�c L Owner or Tenant 7:Y-IM Y c r>�-(A Pe G zq-\� I Telephone No.617-8/ -6.303 Owner's Address 5 S\4Yy tt=1yt/ T-6-AAA-C-6- Is 6-AA }C,6Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building tZ es j "�.te(C- Utility Authorization No. Existing Service o Amps /eo / dL/)Volts Overhead,[�q- 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: ,n SPen ci UQ- n> Com letfon o the ollowin table nw be waived hy the Insector o Wires. No.of Recessed Luminaires 3 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets ® No.of Hot Tubs Generators KVA No.of Luminaires a Swimming Pool Above ❑ In- ❑ o.o mergency I ing rnd. rnd. Batt=Units No.of Receptacle Outlets JL No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of etection and Initiatine Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained TDetection/Alertine Devices No.of Dishwashers S ace/Area Heating Municipal P g KW Local❑ Connection El Other No.of Dryers Heating Appliances KW Security Systems: after No.of Devices or E uivalent No.of Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: - OTHER: No.of Devices or E uivalent Attach additional detail ifdesired,or as required by the Inspector of Wires. • Estimated Value of Electrical Work: S o0.00 (When required by municipal policy.) Work to Start: 719112- Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE JR BOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenaldes ofperjury,that the information on this application is true and complete" FIRM NAME: 6M t'►'1.C—TT 6-L �C1-2 tC�L Se r-VlCt- C LIC.NO.: t5?/ g Licensee: t/til - c(m,v-r-j'f Signature LIC.NO.: i 57/g (Ifapplicable, rater"exempt"in the license number((rn$�. 1561,Address: 79 ,f eZ4 770 l GZ�t 17,W Q�pez/ Bus.Tel.No..Alt.Tel.No.: �7- ^ ��5?0 f *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's ent. Owner/Agent Signature Telephone No. HERMIT FEE:$ The Commonwealth of Massachusetts Print Form Department of Industrial Accidents I Mi Office of Invesdgations 1 Congress Street,Suite 100 .. / Boston,MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly j Name(Business/Organization/Individual): Address: �O O 7 9 City/State/Zip:M t le.�m MJ- d t g q 9 Phone#: 9'7 (o 7— 9 7 '7O Are you an employer?Check the appropriate box: Type of project(required): 1.9.1 am a employer with 3 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]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 g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.$ required,] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l LEI Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContracton that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy olic number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HIM I—FO/2 D TNS U l2A N C& <fom P•4n y Policy#or Self-ins.Lic.#: U$ WCC 60 f gS7!a Expiration Date: 6 a a O 13 Job Site Address: ,�, S Y—`t< U(e—W Few A-+-c 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 eof 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 pa' and penalties of perjury that the information provided above is true and correct Si ature: Date: l a o Phone#: Oficial 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#• Date-6712. k/lz— . a 9462 "oR,,, TOWN OF NORTH ANDOVER O� .�ao;•'�hQ �? le OC p PERMIT FOR PLUMBING ,SSACHUS� \ This certifies that. . .L. '`! °�S. . . . . . . . . .s�y. . . ... . . . . . . . r h �has permission to perform .-L. �'�?'?+!^. `}'`:?�`�?^^?-!. . . . . . . . plumbing in the buildings of . . .fe 4of. ... . . . . . . . . . . . . . . . . at . ,,Q— .(( `�I. 1�.2.�-?. . -?.? !R�'-- . , N rth And ver Mass. Fee` Z. .Lic. No.646.+ . . 1. , . Z2 . .. . . . . . . . PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK wCITY MA DATE PERMIT# JOBSITE ADDRESS 0 OWNER'S NAME P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:O REPLACEMENT:0 PLANS SUBMITTED: YES[] NOQ FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER - DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL t SERVICE/MOP SINK TOILET URINAL __ - WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[D NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITYFJ 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER [] AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application 4eVue 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 co pliant with all P rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Nicholas Sawas LICENSE# 15234 AU E MPQ JP El CORPORATION©# PARTNERSHIP®# LLCQ#E::= COMPANYNAMEJ NICHOLAS SAWAS PLG AND HTG ADDRESS 115 SILVESTRI CIRCLE#24 CITY DERRY STATE NH ZIP 103038 TEL 9788043303 FAX CELL EMAIL I SAVVASPLG@GMAIL.COM ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES I • xw The Commonwealth oflVlassachusetts Department of udushiglAccidents Office of Investigations 600 NWashington.Street Boston,.MA 02111 www.massgov1d1a Workers' Compensation Insurance Affidavit:Build.ers/ContractorslFIectricians/Plumbers .Applicant Information Please Print Leg$ Name(Business/Organization/lndividual): 1 ( S 1 ,L Addxess:� - CityJState/Zip: 303 2"' Phone#: Are an employer?Check the appropriate box: Type ofproject(required): 1.LA T am a employer with LA 4. ❑ I am a general contractor and T 6. ❑New constraction employees(fall and/or part-time)* have liiredthe sub-contractors 2.❑ Tam a sole proprietor or partner- listed on the attached sheet.x 7• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. Building addition [No workers'comp.insurance 5. F1 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),aadwehaveno 12,❑Roof repairs insurance required.] employees.[No workers' comp,insurance required.] .11DOther *Any applicant that checks box#1 must also fill outthe section below showlAgtheir workers'compensatlonpolicy information. Homeowners who submitthis affidavit indicatingthey tie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insuranceformy employees Below is thepolicy and job site information. Insurance Company Name% Policy#or S elf-ins.Lie.#: Expiration Date: Sob Site Address-,"5— Fky1/1 ex.D City/State/Zip:fV. Attach a copy of the workers'compensation-policy Ileclaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine .fine to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations o IA for insurance coverage verification. I do hereb cert nrl I pain an ,penalties ofper,jury i7iat flte information provided a ove is tr a and correct. - Si aiure• p� Date: Phone M ( � — 3 O 3 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 - - ContactPerson: Phone#: i 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"...everyperson in the service of another under any contract ofhire,• 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 shallnot 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,MCL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions sliall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)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 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 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 thatthe 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(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (cify or town)"A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license o permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office oflnvestigations 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: Tho Go onw.oalt�off-0ssa..chusof€s - .epaz�rxteut o�Sndustria�.A..cc�da�ts . 4ffloe ofjimstigatio.w 600Wasbiugtoa Stro,5t Boston,MA 02111 Toll#6x7-72,7:-4900 0A406 or 1-S77�MA.�S�� Revised 5-26-05 az 0 617,4727-774 Date......d..` . ................ NORTH °ft"`°:•1"° TOWN OF NORTH ANDOVER .fir ��=r �• 0 p PERMIT FOR WIRING ,SSACMUS� This certifies that .................................................,-.-� ..:. :. . —�`""'z'........... has permission to perform.. Y................ .o ....................... ..................... wiring in the building of _ .`` "� J -- �'PELECrRICAL ! .... ,North Andover,Mass. at............................. .... oy . .... ..". Fee-Jz..................... Lic.No..��...`�'.:�k........ .... . .... . ..INSPE Check # 8393 Official Use Only �. Commonwealth of Massachusetts y Department of Fire Services Permit No. P BOARD OF FIRE PREVE TION REGULATIONS Occupancy and Fee Checked oe [Rev. 11/991 leave blank s APPLICATION FOF 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 TYPEL,�ALL INFORMATION) Date: 10-03-2008 City or Town of: NQ&TH 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) 5 SKYVIEW TERRACE Owner or Tenant PETTORELLI Telephone No. Owner's Address same Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building RESIDENCE UtilityAuthorization arion 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: NEW LAUNDRY ROOM No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Tota Transformers KVA No.of Lighting Outlets No.of Hot TubsGenerator KVA s No.of Lighting Fixtures 3 Swimming Pool Arnd.bove E3rnd. E3 Battery UnitgNo.ot ency Lighting No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches I No.of Gas Burners No.of Detection an Imtiatin Devices No. of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Num er Tons KW No. o Self-Contained Totals: .......................... ......... Detection/Alerting Devices l No. of Dishwashers Space/Area Heating KW Local ❑ Mumcipa ❑ Other Connection No.of Dryers I Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of WaterKW No.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydro massage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent 7THER:ADD SUB-PANEL FOR LAUNDRY ROOM INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licen- see provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certi- fies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) L � k fav Estimated Value of Electrical Work: $ 1,800.00 (When required by municipal policy.) (Expiration Date) Work to Start: 10-03-2008 Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: WILLIAM J.IANNAZZI,INC. LIC.NO.: 13592A 1 Licensee: WILLIAM J.IANNAZZISi na g _ _� LIC.NO.: 13592A Address: 191 CHANDLER ROAD ANDOVER Bus.Tel.No.:-978-686-7300 MA 01810 Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent �-- Signature Telephone No. PERMIT FEE: k—ZS- The Commonwealth of Massachusetts Ln- Department of Industrial Accidents fOffice of Investigations UT 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): WILLLAIM J. IANNAZZI, INC. Address: 191 CHANDLER ROAD City/State/Zip: ANDOVER, MA 01810 Phone#: 978-686-7300 Are you an employer?Check the appropriate box: Type of project(required): 1.❑X I am a employer with 16 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet.$ E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10. Electrical repairs or additions required.] officers have exercised their 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 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 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 for my employees. Below is the policy and job site information. V Insurance Company Name: ALTANTIC CHARTER Policy#or Self-ins.Lic. #: WC I 0 0 0 54 91 Expiration Date: 10/01/2009 & 10-01-2010 Job Site Address: 381 MAIN STREET City/State/Zip: WAKEFIELD, MA 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 undaiLthh pa`iinns and penalties of perjury that the information provided above is true and correct. Si ature: Date: 10-01-2008 WILLIAM ,,, NAZZI - PRESIDENT Phone#: 978-686-7300 1 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#: VQ4tfi� 24, V% i. PROFESSIONAL STRUCTURAL ENGINEERING P.O. BOX 958 DESIGN SERVICES E. HAMPSTEAD, NH 03826 (603) 329-5540 FAX (603)329-6406 RESIDENTIAL• COMMERCIAL• INDUSTRIAL October 15,2008 Mr. Chris Matey Red Apple Renovations 32 Washington Ave. copy Andover,MA 0 i801 RE: Client Requested On-Site Inspection&Certification of Compliance to Engineer's Specifications for Construction of Second Level Laundry Room above Existing Garage at 5 Skyview Terrace,Andover, North Andover Dear Chris, As per your request,I have physically inspected the above referenced project for compliance to the Engineer's Design Specifications. As inspected on Wednesday,October'l5,2008,the Second Level Laundry Room Project constructed above Existing Garage at 5 Skyview Terrace,North Andover,MA is constructed in direct conformance to the Engineer's Certified Structural Drawing S 1.0 and verbal instructions given. Thank you, Sat J:Moccia,PE gis ed Structural Engineer dent,Hampstead Consultants,Inc. cc: North Andover Building Dept. OF �� cy SALVATORE J. CD MCCIA c STRUCTURAL No.33287 9fGISTER�� FSS/ONAL OCT-13-2008 11 :44 AM THE PLAN $HOPPE 603 329 6406 P. 01 PROFESSIONAL P.O.BOX 958 STRUCTURAL.ENC3INEERING E.HAMPSTEAD,NH 03826 DESIGN SERVICES (603)329.5540 FAX(603)329$406 RESIDENTIAL•COMMERCIAL•INDUSTRIAL October l5,2008 Mr.Oris Matey Rel Apple Renovations 32 Washington Ave, Andover,MA 01801 RE: Client Requeacd On-Site CRer�tyfl�Veof Compli 'to Engineer's Specifi 'ons for North Andover ge Construction of Second Level Laundry S Skyview Terrace, dover, Dear Chris, As per your request,I have physically in the spected above referen • red project for eom Mance to E8m� s Daip Specifications. p the As inspected on Wednesday.October 15,2008,the Second Level Lawn Roo oom Pr+o'ect co e Faolstulg Garage at 5 Slcyview Terrace,North Andover,MA is constructedted in direct confwnance tb the nstructed Engineers Cc tifiied Structural Drawing S 1.0 and verbal instructions given Thank-You, al 1.Moccia,PE i Structural Engineer dent.Hampstead Consultants,Inc. ec: North Andover Building Dept OF BAJ, MOCpA STRUCTURAL H No.33287 'SOMAL rv� Date.l.�. f NORTH 1 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACNUS� This certifies that . . ..�-; `'. �; �<.•...? . . . . . . • . .��f . . . . . . has permission to perform..-!- '!"� - plumbing in the buildings of at . . . . . . . . . . ., North Andover, Mass. Fee-3.j. 4*1'� . .Lic. No./3 .���'. . � 4�LUM & . . . . .NSPECTOR Check # 7373 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (PnntorType) _ MA Date _200 Receipt# Permit# ;r Building Location ZW (`Q Owner'sName Map: Lot: Zone: Type of Occupancy New ❑ Renovation Replacement ❑ Plans Submitted: YeSj No ❑ V FIXTURES Fee: Z y Z N — to W Y J O Z r— W W N Z _j cn Q U Q N O N ¢ ¢ O — W Q ¢ ¢ 2 !" Z O ¢ Z Z a > tlf Z J N — to N W 'n H U W Y Q N U. — a C 3 X ¢ = = ¢ a Q U w 0 c ¢ a W ¢ f- cn o Q w 0 ¢ a ¢ O - ¢ W y Q W to ¢ J Z C C J LLL U Q = 3 3 o z s 3 Y a 0 r Q 'e Q W u. x w a F > F- O N N O Q Z O O N ? W Q O U 2 O Q J J Q ¢ ¢ ¢ O Q I— Y J M N C n J 3 2 F N U. U C Q ¢ M O SU B-BSMT. BASEMENT I IT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name A�' heckone: Certificate Address -6 corporation EstimateValueof Work: ❑ Partnership Business Telephone - ❑ Firm/Co. Nameof Licensed Plumber or Gas Fitter �aWj"61 INSURANCECOVERA I have a curre t liab' ty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, pleas ndicate the type coverage by checking the appropriate box. y A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner❑ Agent Q Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in abovapplication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the per ued for dj pplication will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapt 4 f Ge Laws. By Signature of Licens umf&11_ Title Type of License: Master Journeyman ❑ City/Town APPROVED (OFFICE USE ONLY) License Number I R4mwd 05/17/00 �Ct3Mt�A9N1ACEALTt ®�MASSACFfUSETTS- IN PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THIS LICENSE TO i KEVIN A SCOTT i PO BOX 446 U) WILMINGTON MA 01887-0446 13258 05/01/10 430449 I' i COiIllt>ftOEU�IiIEALTH Of Ss A 6 A b§t-f-f§ IN PLUMBERS AND GA-SP ITTERS LICENSED AS A JOURNEYMAN PLUMBER I ISS'vi_S THIS LICENSE TO � I KEVIN A SCOTT ; t m P. BOX 446 N WILMINGTON MA 01887-0446 24677 05/01/10 430450 E�: , t -_ --COMhr►ONWEALTFi OF�ASSACtiUSETTS REG ST RE4. D AS A PL N CORP ISSUES THIS LICENSE TO KEVIN A SCOTT KEVIN SCOTT PLB & HTG INC N, PO BOX 446 WILMINGTON MA 01887-0446 2438 05/01/10 430451 r ]— _ � t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):j \ Address: 0 City/State/Zip: roun Phone # _ d you an employer? Chec t e appropriate box: Type of project(required): 1. I am an employer with 4. -- I am a general contractor and I 6. New Construction Employees(full and/or part-time)* have hired the sub-contractors 2. — I am a sole proprietor or partner- listed on the attached sheet. I " Remodeling Ship and have no employees These sub-contractors have 8. — Demolition Working for me in any capacity. workers' comp.insurance. 9. — Building Addition [No workers' comp.insurance 5. We are a corporation and its I 10. — Electrical repairs or additions required.] officers have exercised their I — 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.]H 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. H Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatin_a such. I Contractors that check this box must attach an additional sheet showing the name of the sub-contractors and their workers' 1 am an employer that is providing workers'c ensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: \ �A Policy#or Self-ins.Lic. #: ���� � Expiration Date:_ J—lul,� Job Site Address: Vo�rlll F CC IP towns' City/State/Zip: Otl� -NA' - ' 4 - 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 t1,500.00 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 pai d allies of perjury that the information provided above is trued orrect Si ature: %%CZ Date: Phone#: OP' Official use only. Do not write in this area,to be completed by city of 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#• y No. r-�� 14, Date �oR,h TOWN OF NORTH ANDOVER s • ; Certificate of Occupancy $ _ /Frame Permit Fee $ � cMuBuilding/Frame 9 - Foundation Permit Fee $ •a Other Permit Fee $ TOTAL Check #- .� '� J `> Building 4nspec or t' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING JL4 `1f0� `iQB� 8C13� BUILDING PERMIT NUMBER: DATE ISSUED: /� D y) cR �. s (/ SIGNATURE: 06040 /1�` Building Commissioner/I ctor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O S KI v �.�w�e2 (/yl yl y�j Map Number Parcel Number tri V D `C 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v I 1.5. Flood Zone Information: 1.8 Sewerage e Dispose 1 1.7 Water Supply M.G.L.C.AO.154) System: Public 0 Private ❑ Zone outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record S e' w 7-c oVA 2, 04• Names Pr nt) Address for Service Ile- Sign ure Telephone a 2.2 Owner of Record: 10 Name Print Address for Service: O Z Signature Telephone rn SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor. O 1' License Number .a 'Address lExpiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number rn M Address r Expiration Date Z Signature Telephone 9 SECTION 4-WORKERS COMPENSATION(AG.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.......❑ No.......❑ SECTION 5 Description of Proposed Work check altapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 1 Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: // 7 A Ai y SECTION 6-VSTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building ' (a) Building Permit Fee 1� aU0 a Multiplier y 2 Electrical (b) Estimated Total Cost of L_ Construction 3 Plumbing Building Permit fee(a) Y (b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT N 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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/A ent Date , NO. OF STORIES SIZE t BASEMENT OR SLAB SIZE OF FLOOR T MBERS 1ST2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GHWERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE T Town of North Andover NORTH ytt 16,1 � 4y6 O Building Department o 27 Charles Street ` North Andover Massachusetts 01845 _ (978) 688-9545 Fax (978) 688-9542 4 `°`�" �• ��SSACHUS���� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location Signatureof Ap licant z� zdd d Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. � r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print .Name: Location: City Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. 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. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# 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 A ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION APR. 25. 2000 12: 32PM BFI NE AREA BUS CTR N0, 0271 P. 2 1 i April 25, 2000 North Andover Building Inspector Re: Construction Dumpster @ 5 Skyview Lane Inspector, This correspondence is intended as documentation of Andrew Chaban's contracting BFI to provide construction dumpster services for his planned addition @ 5 Skyview Lane in North Andover, MA. BFI will be transporting all debris deposited in our dumpster to LL&S, demo transfer station, in Salem,NH or to Peabody Transfer Station in Peabody, MA- I am available during regular business hours @ 800 438-4103 x164 if you have any questions or need any further information. Sincerely, avid Languirand Sales Project Coordinator ;185 Dunstable Rd.•Tynpbpro,Massachusetts 01879 Phone 978-549-7564-Fax 978.649-4291 soxa�o-canwme,� NORTH w Town of _ 4Andover O _ `.:` TO No. Z Z / dower, Mass., /6 DO COC HIC HE WICKV ADRATED PPa� 7 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.....�ti. . ...r...�.....w.............�..�..A..b..�+AuBUILDING INSPECTOR.................................. � Foundation has permission to erect......Irf.N ........ buildings on ...... Rough to be occupied as...... 3 AsF r» .&01�jjW Orir sAooO Chimney ........................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. m 0/418 P A S 0 � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST . 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' N° 2 7 4. 5 Date. .......................... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING )• ,SSACHUS� q • i . r � This certifies that %` ' r has permission to perform ........ . . wiring in the building of................II/X/ r ................................................................... at...... '..... ......:............................... ....::: ��:��..� North Andover,Mass. Feel .............. Lic.No. `..`::'. ... ....,. ... �:.......................... ..... / ELECTRICAL INSPECTOR Check # I WHITE: Applicant CANARY: Building Dept. PINK:Treasurer lugThe Commonwealth of Massachusetts Permit No. Office Use Only� Department of Public Safety Occupancy & Fee Checked (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Effective 3/90 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 // �2 —os 19 Town of To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 5 s A`NVPole No. Owner or Tenant dee t J Owner's Address ,, Is this permit in conjunction with a building permit? YesPurpose of Building � s „, �p No • Utility Authorization H0. Existing Service v2- /imps v / may?Y®Volts Overhead ❑ Uadgrd • ❑ No. of tkters Mew Service /imps / Volts Overhead ❑ Und d❑ gr Ho. of Meters Number of Feeders and Ampacity Location and Mature of Proposed Electrical Stork //7-9 W7 LA No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total RYA -No. of Lighting Fixtures �� Swimming Pool -Above( In- grnd.❑grad. ❑ Generators RVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Snitch Outlets L) No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and T1 Initiating Devices' No. of Disposals No. of Heat Total . Total Pum s . Tons Y1W No. of Sounding Devices No: of Dishwashers- Space/Area Heating KW No. of Self Contained + • Detection/Sounding Devices No. of_Dryers Heating*Devices KW Local❑ ManicipaL ❑Other No, of o. o Connection o No. of Slater Heaters Signs Ballasts Low Voltage Wirine No. Hydro Massage Tubs No. of Motors Total HP OIHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Lia lit Insurance Policy including Completed equivalent. YES(l]-NO D I have submitted valid proof of same 0torthis noffice. YES Nverage a p�tantial If you have checked YES, please indicake•-the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ On ER (Please Specify) General Liability . 12/31/00 Estimated Value of Electrical Work S iration ate Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FM NAME Boissonneault Electric Corp. -LIC. No. A11823 Licensee w e /Lf. �P_ �;, Signature LIC. No. Address Address 1.9 Chuck Drive, Unit #6, Dracut, 01826 Bus. Tel• No.�97814 4-0383 OWNERS INSURANCE WAIVER; Alt. Tei. No._(9781458-9977 I sm aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General-Us, nand that my signature on this permit application waives this requirement. Owner Agent (Please check one) _ Telephone No. (Signature of Owner or Aftent) PERMIT FEE S -- 04 1 v Date............. ........ NORTh TOWN OF NORTH ANDOVER 1-?pya..ao ,e 1ti Cp PERMIT FOR GAS INSTALLATION a� ^a ,SSACHUSES V This certifies that . .,. .: . . . . . . . . . . . . . . . . . . . .: ... . . . . . . . . . . . . . has permission for gas installation•. . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer CAS6CMN 1 . MASSACHLISET rS UMFORM APPLICATON FOR PERMIT TO DO GAS FITTING ype or print) Date `p� ii� 19 6o NORTH ANDOVER, MASSACHUSETTS Building Locations ley/lzw 7-e Permit g Amount S "p Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ n •r J J] n n J Z - ui zIn Cn BA S' E .vt ENT � ITr FLU O R 2 N 0 FLOUR 3 R D . F L O O R Tr if F L O O It 5T If FLOOR 6T if FLUOR 7'r 1f FLOG It 3T 11 . FLOOR Name or type) �2— k �� ��!C G Check_ : Crrtiri Installing Company i'7 �rP- Address �� "�/' / t/ e ❑ Parmer. Business Telephone ��j ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: ( h4ve a current liability Insurance policy o s substantial equivalent. Yes ❑ NO F7 ifvou have checked M. plea e indicWe the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 1=42 of the Mass. General Laws.and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agenr Owner ❑ ,Agent ❑ I hereby certify that all of the details and information I have submitted for entered) in above application are true and accurate to the best ofmv knowledge and that all plumbing work and installations pertormed under Permit Issued For this application will be in compliance with all pertinent provisions of the.,Ivtassachusett RateCia5 C de and Chapter 2 o the General Laws. Bv: _ tune of Licensed Plumber Or G ' Fi r Title Plumber Ciry/Town ❑ Gas Fitter Icerise NumoCr j[ lasler APPRU'v"ED I)FrIC'_tj. :-,N1_Y) Journeyman Date. -.�-. l.J. . No "oRT►, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �sSACMUS i This certifies that . . . . . . . . ... . . .?. . . �.' . . . has permission to perform . . ... . . . . . . . .:".'.. . . . . . . . . . . . . . . . r plumbing in the buildings of . . .-.! t :'�j:. . . . . . . . . . . . . . . . . . . at.). . .-G'r"e, "-u-�`:. !.-!!'� ' "`�. . . . . , North Andover, Mass. Fee. . . . .� . .Lic. No/:�� �6'. . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH.ANDOVER,MASSACHUSETTS / Date� , J �� 11ICw �.tb ll If//) C l�►�j� � J Building Location Owners Name "�/C /��/ / Permit# Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes r No El FIXTURES z w cr a >4 w V a 'c a x w w d a ;T-4 w d E, a a z W {� .] A A ►.� Ed- d C� � SFE)E34V1)L II�cIIVIIVT ]S)C FIDQ2 M FIDQZ MKaR 4MRIM 5M FifM 6MROM 7IH ROM SIH FLOOR or ibstatllinin type) (CIO .e Check one: Certificate fag Company Name C V7,/ „ "l 7 EI/Iforp. / 72 c/ Address Partner. Business Telephone (off- Firm/Co. Name of.Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 'V' Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance " Signature Owner F� 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 M ac to flu g e and Chapter 142 of the General Laws. BY '71pature oiLicensea numoer Type of Plumbing License Title City/Town icen e MEN= m er — Master Journeyman APPROVED(OFFICE USE ONLY Date...4-- ?,5- --z> N2 2363 .......................... RT#j TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING S CHUS 77 Thiscertifies that .................... ................................................................... has permission to perform ......... .... .I............ wiring in the building of... .. ..... . ...... .�. at ...... ,North Andover,Mass. ................... - Y ..................... Fee ...... Lic.No��'�/ ELECTRICAL INSP ECMR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer - "•.....,w,rweGilrtY of Mauarchuseits o:rt�. rH o�tr �l r Depamnc a of Pubic Safety �. WM Olt MR PpEVOMm AEGtlI:J1TtONS 57T CMA.1tt0 13/00 °"«r"`r A ►..c*.or.+ J APPL1GATtON FOR PERMIT TO PER OR ELECTRllICAS WORK 'Cos $27 Cm 12.0 . Uet�sa p� � �•� �aea �. AM - . . Cfty ofn.-r r G. ....,..._- lAa.wider `�`'�'�' uspomr of direst � �dr� � P�it<to pecfoca.d�t lac <de. til iMoack saribetl ba w. Zo attitaa.�84t�et tltibdc� 5..�: ^C.Y^ ✓ G G Aeter.0r1nt___ ,c �,✓ �,( [. �, n Vis:. ... u_ hilt pEterit tp eoajtu tion.vitb a. ui-U ►S para Ct Tss:. tb.Q (Clock Appropriate .4 Izat to. R4cPose o!SniietiaS_r__ c �c �tslttad Q v° a❑ Ho. of meter'sMP W No. of Hetets Location:ia�l; a o#'-tticopoaed Blact:�s2 itwc>c tq ogx - '" "�` itbon No. of 3YaasEoreere A o. (kyra�al :w-• //�pt �Y'�^i"� �iM 1, '.•/C1As XVA - Qs f � °b�,..,�•_dl�Yils - mow! ' g. -»kb. exIA rel' P A No. of Zones : . No. o!: � � �;��.s�ret• - •. ..,..._,..... �� • ol,Dsteetioa and , of -,,� S �• No- ZMtitattt�t Reviews wy w o G SourAlaig Devices blSwr�ttdi�Da ---......_.._. 4 . } t tea rs vf r Mnother ►a "spt' �, y� aNR o b aabatantiwi 2! you7`bitra-eb losil ;sP2 3�adtia ti 'e�yo` s o YBSu NO Ej ei>aekit tl�e apprepriai n box. (Fiona Specify) v, 7 d itstlatted TRUM o!`Biou-S'l work 8 �O.4 C� y-�J.'� rat ate ®Z� to atrnrt i8naa a.Mr tea po"Iti" of perjw,t . YDB NAH9 ca `LXLia3 % Artdtteaa_; °i fJ c c� inn a y Beta. 1`. l►ta, 4 - 3,y -q �s 3l1S{OtANt,�i Alt..Ssl. .lto;. y�� f YRRt I,�:awre that die Li outaa Elia 1ptuzraiteik a Au ssiitefaT eigva3iae ail: by lwas>iehivattr X02 t siZtubairb bit s Permit sppiifealtaA aiiiiea tAia`riqutr�t�nnt. Owner 11goMt..., rill k aNYrl) S 2/6) ' Mara o r or VeND k+,-..:.y. :n ►s< <. ..m CI:jU, -y `�� � ���c� r� - 7�e P� *,'.5 G 87 3 9 p Q • f f t � 5 .1 I From: Tom Sylvester Pager: (781) 841 - 6415 Phone: (978) 957 - 3428 OZ'Z' ',C'a Co: � �� `��- co 14 Date: Job #: For:_"_Y_�?w _ AYt- ___._ Property Name: S S Kyvz`�u. Tom , Job Location: Job Updates OESCRUMON PRICE AMOUNT D '.. ....-. ��.1............._........... 't..:_ti-s.._.._._....._...... ......... ............_.r ...._._r ... - - .._._........_...._....__.._...... ..... 1 e - -. n- ._.._,1.._n.G.. .... ........ ..._.. ......... ............... ... /.........7-Z.... .._. .-_...... Q,._.._..._v...__........ __._ ........ ................ .. .........._. ..._.. a........tc_�... .. - .,............. .... .f ....-l'1 n -c. _... ....J.... ............ .._... ...__.gid'........... '..... .. ��t.,�. ..-....... ............'af . _ ._........ ............__.._... _ .._.- ,c --._..... _.. __ ...-�-� 2_. .o u......._... --c- G ;-_d.....- � .. - _�( ._.._t .....s ........-...:H_ �--- . .... ......... ..... �nz.... �.... �..............._.__ .....................__.........�._........... ............-.................................................__..........._........._............_...........- _-......................-.......... _ _._...............-............................_............................... ................................ .............. ✓T 1'.z ... . ......................- ...._..-. -..............................-.._-............ .........--.......I.._.._._....................._ ._......._.......-- --......._-.............._......_....._............---.._...-. ..-.-.-........-..... _._..-....._....__....... .... ..-----............_._..........._.........................._......._.....__........._...._................--..-......--...............---_-...-....._............... .............. ....... . ......._.............................................._-............................................................_............_............_.............._._....._.............................. .................................................................... ...--... ........_....................._................-.............�...... .. --....................._............._.._..........---....._..._...__................................._._....._._..........._................_..__..............._......_.................................._._..................-...__.... ..................._...................... ...-. .__.-._.... ....._...._..�_......-. ............................... . ....._...._ .... _ _ _ _ .......................-......................................................._... ...._ _._._....................................._.._...__.............._.............................--...... .. ......_........__................_.._.. ............-..- _....................._. ..................._..................._.............................._.................._.............--.._._.............__...............__......................................_.....-.............. ........................ .. ........................._'.-...- . ............_.................................................................._......................................--........................--.....-.............._.................................................-... .........._....... ............ .�.... .... _._............. ........................ ...._.............. ...........................................................................................................__...............-_...._................................_-...._.................-_..-----------.- ...._...._ .......... - ................................................................._............_..................._.................._................_....... _. . . ..._....-........... . ....................I ...... --..__._..............._...._...--..........---............-......................-....._............................_......_..._._...................................__........_................................................_......._....................................................................... .............._.. .................._......... ......................................................................._.....-....... ................................._.....----..............._......................._.......--........ . -- .....--._.....-..-..... ... ........ _............ i.........-.... _..................... .................. ......................_............................_.............................................--......_....._....__.....................................-...._..._..............._.................._........--................................ ......__..... _-.._-...................,._......... ............................ ._...-------- ............---..--.........._.......------.._._........................._.........__...._............_....................................-.................................... .. ..........._......................... .............._- _.................�........... I. .........................._......_.........................................................._...........................-............-........................-................................................_............................... -................... ..................................... ................�.-......... �Si 43 4 Date. . .. ...... .. .y....... ` TOWN OF NORTH ANDOVER pf ��ao ,a'Iry� 0 a `p PERMIT FOR GAS INSTALLATION s SUCHUSE { Ais certifies that . *� . '.-. .r . . . , . .' , . has permission for gas installation %: ``. . . . . . . . . . . . . . . . . . . . . . in the buildings of . :. .' ` : -'. . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . .. North Andover, Mass. Fee??. . '. . . Lic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO AS G f ..fit:•. .M _ Type or print) Date� 19 NORTH ANDOVER, MASSACHUSETTS / / Building Locations Permit 9 Amount S ?�_ Owner's Name , � "I.Id New Renovation ❑ Replacement ❑ Plans Submitted 11 Z u7 In \ I ` n n z ;:z Z Z C - n n L v y W Z C m 7 SUB -BASE ,M EvT BASEM ENT IST. F L 0 0 R 2N D . FLOG R JR D . FLOUR Tr if . FLOG R ST If . FLUOR 6 T If . F L O O R ?T I1 . FLOOR 1� 3T11 . FLOOR 1 (Print or type �� Che one: Certificate Installing Company Name Corp. Address ❑ Parmer. a Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter ] ..j + INSURANCE COVERAGE heck o n ! have a current liability Insurance p5 .cv or it's substantial equivalent. Yes No❑ If you have checked ves lease i tate the type coverage by checking the appropriate ox. Liability insurance policy Other type of indemnity7-1 ❑ Bond ❑ Owner's Insurance Iver. 1 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 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations er tbrmed under Permit Issue for this application will be in compliance with all pertinent provisions of th eMasi4busans S Gas Code and Chapter 'of eras Laws. Bv: Signature of Licensed PI mberFitt`erf� Title ❑ Plumber Ci �C Cir-//Town ❑ Gas Fitter License iNumoer ❑ ivlaster APPROVED IUFnci-UsE ONi.v, � umevman 1-' Date.' . Z2- -,, r 3 8 TOWN OF NORTH ANDOVER 000n PERMIT FOR PLUMBING 1SSACMUS� ` ' This certifies that f -. •ryy'.r ..�'` Chas permission to perform . . . . . . . . . . . . . . . . . . . . . ji�plumbing intthe buildings of`. . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . I tit . .-. . . . �. . . ., . . . . . . . . . . . . . . . . . . North Andover, Mass. i 7r c Fee s!:'!. . . . .Lic. Nd?� .e . . . . . .. . � . . . . . . . . . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Dab� Owners Nam [/ w) Permit BuildingLocatid e v Amount Type of Occupancy New)g� Renovation Replacement 0 Plans Submitted Yes No FIXTURES rA w arA ° a a a z H a x acr d a a x aCna a w d w a a27 w F A r. x a E Q d W E~ Z > p� d a Q a a d H Z A A a F d x ca SOMME B��v>Fra' ISE FLOCK 21'D FLOOR 3M FLOCK 4MROM SIH ROM 6'M FLOCK 71H FIOCR SIH MOOR R A (Print or type) v ��.�C�� ''_Ch one: Certificate Installing Co pant' ame '`�/y/� � Corp. Address artner. Firm/Co. Business Telephone Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ❑ Liability insurance policy Other type of indemnity E Bond Insurance Waiver: I,th dersigned,have been made aware that the licensee of this application does not have any one of the above three insurance w Signature Owner Agent i I hereby certify that all of the details and information I have sub 'tted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and install 'o performed under t ed for this application will be in compliance with all pertinent provisio us tate Plumbin ter 142 of 'general Laws. By: 1 01'LiCensect �ype of PI , bing License Title City/Town icense Numner Master Journeyman APPROVED(OFFICE USE ONLY Location Q P1 l 293 Date .. G t NORTH ' TOWN OF NORTH ANDOVER F „ Certificate of Occupancy $ Building/Frame Permit Fee $ JACMUSES� Foundation Permit Fee $ Other Permit Fee $ m d �o Sewer Connection Fee $ o. Water Connection Fee $ TOTAL $d) Z{ 3 {J^b Building Inspector 000.00 PAID/ ` ;�� 8503 Div. �Abl' Works Location No. 128 Date A-*� "OR,e TOWN OF NORTH ANDOVER Ott� ,h p Certificate of Occupancy $ �a t r Building/Frame Permit Fee $ Foundation Permit Fee $ 0o �.. Other Permit Fee $ Sewer Connection Fee $ ' Water Connection Fee $ TOTAL $ 5ti _ i Building Inspector 150.00 RAID Div. Public Works Location S��Y� . Lit No. 1 2� Date cvr NORTq TOWN OF NORTH ANDOVER ' p Certificate of Occupancy $ # " Building/Frame Permit Fee $ Y x �•�s' °'�t�' Foundation Permit Fee $ �,4 MUSE Other Permit Fee $ 2 Sewer Connection Fee $ Water Connection Fee $ ., TOTAL $ Building Inspector T? /. Div. Public Works o PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. 7l PI'5--e- Ze"J PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK iPAGE ZONE I SUB DIV. I-Of NO. LOCATION ,/l^/��i d 73y� PURPOSE OF BUILDING OWNER'S NAME Kb��Ll-%lw w�kw'A 't�D. 1. � NO. OF STORIES SIZE tl OWNER'S ADDRESS L� �U�D��Df BASEMENT OR SLAB J L. ARCHITECT'S NAME �j�i ��'j� 6Zs SIZE OF FLOOR TIMBERS IST aY�� 2ND 021((C) 3RD r BUILDER'S NAME,jl•` 1rn�w � SPAN /Sry ` DISTANCE TO NEAREST BUILDING 30 I DIMENSIONS OF SILLS DISTANCE FROM STREET �� POSTS3�a /_/�//A/ DISTANCE FROM LOT LINES-SIDES •7/� REAR j '� GIRDERS /- •`o�wle AREA OF LOT 2 � 41�- K•� FRONTAGE 1 HEIGHT OF FOUNDATION I�GJf (V THICKNESS IS BUILDING NEW 'o' SIZE OF FOOTING C�JPe X �o f/ G IS BUILDING ADDITION `L✓A/ MATERIAL OF CHIMNEY �� IS BUILDING ALTERATION LSA/V IS BUILDING O SOLID R FILLED LAND WILL BUILDING CONFORM TO REQUIRLEtMlENTS OF CODE �yP 5 IS BUILDING CONNECTED TO TOWN WATER S BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER ye rj - IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS u ll 3 PROPERTY INFORMATION P� r LAND COST SEE BOTH SIDES W� / EST. BLDG. COST w �+ PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ FT. PERMIT FOR FOUNDATION ONLY EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 REGULATED BY PARA. 114.8-5. B.C. SEPTIC PERMIT NO. _- ELECTRIC METEPS MUST BE ON OUTS ID LDING 4 APPROVED BY r ATTACHED GARAGES MUST FORM TO STATE FIRE REGypNS PAID loo -_ PLANS MUST BE FIL AND APPROVED BY BUILDING INSPECTOR FEE • DATE FILED a�77 V s ■UILDINO INGPECTOR SIGNAT RE OF OW)CER TH ZED AGE l + F E E 13c c PERMIT FOR FRAME/BUILDING OWNERTEL.# PERMIT GRANTED `f CONTR.TEL.#y V � r(JC1��-yam ®cT7 Y t�1- ,9 g��- DATE: FEE PAID:--- e ��2 CONTR.LIC.# _ -g co f H.I.C.# LMMFEE loo lbsS5' IC. Ito, DUE I E KRUIY 0 172 g i Jk � (b-15� BUILDING RECORD e_ 1 OCCU ANCY, 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM p 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 f CONCRETE CONCRETE BL K. ---111 PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL-, UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ 'L 1/1 '/ FIN. ATTIC AREA NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOOR CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH __ ASPHALT SIDING HARD!J'D _ ASBESTOS SIDING _ COMMGN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ONFRAME . BRICK ON MASONRYATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIORPOOR _ AD UATE I NONE - 5 ROOF 10 PLUMBING w GABLE HIP BATH (3 1) , GAMBREL MANSARD TOILET RM.M. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR - TILE DADO 6 FRAMING. 1 HEATING WOOD JOIST PIPELESS FURNACE F CED HOT AIR FURN. - TIMBER BMS. &COLS. TEAM STEEL BMS.-& COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING /?QPM RADIANT H'T'G UNIT HEATERS GAS il.. . .bTibl 7 NO. OF RO MS OIL � B'M'T 2nd _ ELECTRIC r e; 1st 13rd NO HEATING � � j ORT Town of Andover i No. 128 ft= -s -Z over, Mass., 19 ctc' oLAKE COC HICHEWICK OPATED C-1 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.. .....3).6i era W I :�' ..V.�ka ................. Founclatic, "Ib,............has permission to erect-4100 ......F".Mlk— buildings on ... ....... Rough to be occupied asQ(k*. M. ...rAM Lg%�>AOCA M14P........... ..... .....44(,L ..................... Chimney provided that the person accepting this it shall In every respoct��onform to the terms of the application on file In Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough PERMIT IN M(WfA�4—Lq" FEE PAID k 02 Final •S-2) ELECTRICAL INSPECTOR UNLESS CON tJ T S Rough 0S Service .......... ........... _�,,. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building 't v R Display in a Conspicuous Place on the Premises — Do Not Remove I al No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT r � E FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or ,landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant .lfills out this section***************** APPLI CANT: �{ s Ne► oc �DczCS �i � ®ArcT�ea�, .o Phone p LOCATION: Assessor's Map Number Parcel Subdivision aAt ANXOLeg AWLA7 Lots) &- se StreetS�NV i Gu) le-rra ce— St. Number ************************Official Use Only************************ RECOMMENDAT ONP 70FYIOWN GENTS: Date Approved Conservation Administr for Date Rejected Comments j ' � �Q 0 Date Approved LAI it 197!5- Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved �l Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections __Qr-4) ¢->3-95 - driveway permit J-1�Lc� 4-13-9S5 Fire Depart e t�}t_ yA-k,*-d e- Zt:(. ���fi Received by Building Inspector Date a 2 roA r rJl,: --- 5 / N/ 15z Q 93v� v. JJ mu" Apr wL 9� sun FOUNDATION --BUILT W"m a I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED LOT 58 � ON THE LOT AS SHOWN ON THIS PLAN AND THE NORTH ANDOVER TATES LOCATION DOES CONFORM WITH THE FRONT, SIDE, NORM ANDOVER, 1[A AND REAR SETBACK REQUIREMENTS SET FORTH IN Nw6m F= THE TOWN'S ZONING BYLAWS AT THE TIME OF TOLL BROTHERS INC. CONSTRUCTION. I FURTHER CERTIFY THAT THE law w PARK ikVE STRUCTURE IS NOT LOCATED IN THE SPECIAL W=?WR0, NA 01681 100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT PUNNING BE USED FOR THE ESTABLISHMENT OF PROPERTY � � � �� LINES, ERECTION OF FENCES, OR CONSTRUCTION OF ADDITIONAL STRUCTURES ON THE LOT. m' '°M) ATQM MUMU` I" oso� (Bos) 906-4LW sar (60) 90s-4064 MAP NO.awo*c COM NO. 25o©lte DATE: Go --Z-7'3 r, 4Q' CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number qS-128 Date 28 �`iqs THIS CERTIFIES THAT THE BUILDING LOCATED ON I C —T� 4 MAY BE OCCUPIED A IN ACCORDANCE CA WITH THE PROVISIONS OF THE MASSACHUSEETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ,, NSlN6�OM P• ADDRESS b re u R4 • e „yam . • 7 '^�M�' tZI Ins ector 8 P F ORT Town of KAndover � L r:: ,.:r -; t" No.' 128 R t: dover, Mass., APPL_- 19`tS O <Vl rnctwCn � �V 9 AERATED PP '(� BOARD OF HEALTH E Food/Kitchen PERMIT T D Septic System K$x(Sl't16TD ��o `.��\ BUILDING INSPECTOR THIS CERTIFIES THAT............................... .................��................. .. ��►lam................... oundation S I?tq has permission to erect.0�P..... Mlle-.. buildings on .'��........54. 1. aua..77L�.�. 0. ............ ..L ���-- x,19 I to be occupied ......... . ......2.......44-L...4�"4z' ...................... y l this er it shall in ever res ect(conform to the terms of the application on file in provided that the person accepting t s p m y p pp 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. PERMIT FOR FOUNDATION ONLY PLUMBING INSP CTO VIOLATION of the Zoning or Building Regulations Voids this Permit. o REGULATED BY PARA. 114.8-S. B.C. „ � 1 � �ci FEE PAID l o�� PERMIT EXPrig M �� -%� ELECTRICAL INSPE O UNLESS CONC T S l ough / i ..........:.................... :).....>.. C� � . .....� ervtce Z�� q 5 PERMIT FOR FRAMUBUILDING BUILDING INSPECTOR /( DATE: s 41q1C FEE(P}�,#�;E 2�a rmit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove i + No Lathing or Dry Wall To Be Done FI DEPARTMENT Until Inspected and Approved by the Building Inspector. / Burner � l�.R) Street No. h`' PLANNINGYAC ��Z_PlcCA CONSERVATION �� 1 FINAL _ Smoke Det. SEWER/WATER L��1O FINAL DRIVEWAY ENTRY PERMITS � 9 h-. Location /u No. J Date 40RT" TOWN OF NORTH ANDOVER � 9 ` Certificate of Occupancy $ ♦ '� ♦ r •�,s cNust C" Building/Frame Permit Fee $ s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i i �. , I� : Building Inspector TOWN OF NORTH ANDOVER • BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING rotes ai= , BUILDING PERMIT NUMBER: j� DATE ISSUED: SIGNATURE: Building Commissioner for of Buildings Date SECTION i-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: S Vile U/ ��v v Of 2 �� Al, A yl do v e V ' Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 2TO Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'red Provided Required Provided g° �i' 7.-2-"— 1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private �❑ Zone Outside Flood Zone Municipal )'} On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record /�, .� /J i Y1 ye a V q� S�1�✓/ eW /f✓Yo1Gt, /� �Yl�y`pi'e /v//IZ Name(Print) Address for Service Qj P Signature Telephone 17 1, 2.2 Owner of Record: \J P Name Print Address for Service: O 4 z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: • License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 v Company Name Registration Number M Address r s Expiration Date z Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) ' Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ I SECTION 5 Description of Proposed Work check all a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify I Brief Description of Proposed Work: V- �3 !, Y eddiYeax., ®-(, :to 15 '.f SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be (#i 'IC ;USEbNLY Completed by pertnit applicant 1. Building C� q (a) Building Permit Fee /� Q Multiplier v 2 Electrical (b)Q (b) Estimated Total Cost of 3 z 5 Construction 3 Plumbin / SS Building Permit fee(e)X (b) 4 Mechanical HVAC) 8,32"7 air 5 Fire Protection ! 6 Total 1+2+3+4+5 Q Check Number SECTION 7a OWNER AUTHORIZAT ON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, _1 T I d✓e w /V!- C 1�c, Gw h ,a Ow�er/ thorized Agent of subject property Hereby authorize 414 06'0-Li/ J�, C j7,4 GG 17 to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date 4 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I> &,e.,l �����a� ,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 t Print Name �y L.ea c, Signature of Owner/A ent Date NO. OF STORIES SIZE a3 X BASEMENT OR SLAB C /QG SIZE OF FLOOR TIMBERS I s 1 16 Ya 6.3 2ND 3RD SPAN 2 DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS l� SIZE OF FOOTING X / MATERIAL OF CH ,4NEY Q fv tc-p t%1,-t- IS IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t r FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT �f iVdKrr a 611,46411 PHONE �??� " �l� 7" 3 71 ASSESSORS MAP NUMBER / 8 Z LOT NUMBER P S SUBDIVISION N©< AWdQO-e4LLOT NUMBER STREET w �� STREET NUMBER �'� J ........................................................................... OFFICIAL USE ONLY RECONIN ENDATIONS OF TOWN AGENTS 23 ,ir"a4 2ezr, ■ (� ■■■■■■ ■. _p ■■.. �` ■■■■■■■■■■■■■■■..■■..■.■■■.■■■...■..■■■■■...■■.■■. ..■■■.■■■.■■ B oh1C'X J� �{ LM V --1�l" DATE APPROVED / CONSERVATION ADMINISTRATOR f ATE REJE D COMMENTS esu ri2- DATEAPPROVEDGT/Ti/OO TO P!� DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS D WAY PERNaT / c,G / /;z Do DATE APPROVED F DEPAR DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE s, • �t-�co N r N 0) -� ( . Ai 2 • r f� TO 111EgrinIpLtrl� ACID ITS 1111.E IN&UHL•R ti . S. MORTGAGE INSPECTION PLAN I CERl1FY MAT TIIE HUILDIIIGS &IIOMI DO ( COt1FORM 1U SEII3AGC REOUIREMEIITS LO WID IN I.E. (F1'tOfIT, SIDE k REM SETBACK ONLY) Or Norte Allclovt1j. NORTH AN DOVER WlEN CCNSIRUOIED, W ARE EXEMPT FROM V10LATION HA'LARO RHEA ENT"ORCEMENT ACTION UNDER MASS, G:L IITLE VII, alAPTU1 40A, SF.ClioN Y, 04ESS OT11ERMSfa f{ lEMASSACHUSETTSMASSACHUSETTSI PURTIIE,1 CEHIIFY 111AT TMS PROPERTY IS Not LUCAGLOWEDUIMASSACHUSETTSt UIE ESTABLISHED FLDUU 001AMUNITY PANEL NO.; 250098 0006C DATE: c DEED 11115 COL"'A,IY IS IIUI RESI.OIISIOIE FOR Al{Y IIIUE,IIUIIES MADE SUBSEQUE1IifT0211E RECCNtUEll -----_ DATE OF 111E LAICST UFZU DF fiF.CoRU. Hook _ 3773 PAGE _ ()^9 WIE11EV£H OUILDIIIGS "'RE S:ION41 LESS 711AU OIIE FOOT TROI.1 111E PROPERTY LINE IT IS ADVISED 111AT A MORE PAUSE SORWY HE MADE TO VERIFY 111ESL•' mCASUItE1aF7{1S CERT.'IID. i 5 M111FICAT10t1 IS HASFD Ot{ THE LOCATION.OF SURVEY NARKLRS OF O111EHS, AND DOES NOT PWI HK MA E SENT A PRQf'ER lY GURVEY. VERIFlCA11OU or-Unt EY PAGE- UAY 131! ACCCQPL1Slik.D ONLY BY AN ACCURATE, IL16�RU1� t y� � D {U OFIZEIS, AS SIIOVAI, 1i,7 Pwj f .7; l 18 DATED_. 11115 CER1111CAT10,2_TO BE USED FOR. 1t1aCGE`F'Ltf1' ES ONLY, —_OFFSETS AS SHOWN Fs __ ,, -�'- vi'• Ii F:lulli:T 1 3 199 TO HE ��� `, USED FOR ME EpT STABUSHM 1: F GAWUrtrnY LUIS'S: SCALE: BRADFORD ENGINEERING CO . PA. BOX 1244 JAUES W, BOUGIOUKAS ft:L`:5 #9529 IIAV ill-1 MA. 01831 IEL (608) 373-2396 J FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT / ,, t-s hP /V 010 611 PHONE ASSESSORS MAP NUMBER G LOT NUMBER FL j SUBDIVISION LOT NUMBER STREET 51<V vilettl vy C STREET NUMBER 5� OFFICIAL USE ONLY RECOMMENDATIONSOF TOWN AGENTS ..........{{....�.1.�........ DATE APPROVED 1 7, ✓CONS VATION ADMINISTRATOR b DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Town of North Andover of NORTH + o Building Department o 27 Charles Street North Andover Massachusetts 01845 Z .^ (978) 688-9545 Fax (978) 688-9542 o[�KWwKM �0R-Areo CHUS�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed o it /at: Facility location Signature of App ica t y` �y 2 0 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. t NORTH Town of North Andover Building Department p 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta S"`""5e Building Commissioner (978) 688-9545 ,`(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE I /9 f 0(9 JOB LOCATION J kjV+`e y✓ 7• vy-ve e Al, Pmaloyev fVA 0156 ?,5"— Number Street Address Map/lot „HOMEOWNER X e, ✓c,n/ A 61h4,10 779'-61$r.7-3997 9r8�5��'8' 8'30,0 Name Home Phone Work Phone PRESENT MAILING ADDRESS �� �"��l I/►"e)A1 7"8YYaiGG• 41, 14riollovev �. City Town State Zip Code The current exemption for"homeowners"was extended to include owner-0ccupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requir ents a that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass, 62111 Workers'Compensation Insurance Affidavit Please Print Name: Ao dy Q LI/ /y. 6A,31600 Location: 5 5 k Vvie-w7'<- ;/Y ,::v G Citv �U / fr U1 d!o V P V I / Phone (9 $ X am a homeowner all w rk myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. 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 ray-b� ed to the Office of Investigations of the DIA for coverage verification. 1 do herby certify under the peing and pen es perjury that the information provided above is true and correct. Signature Av), reliJ / / Date Print name (. l�G��^ Phone# fG , �'f 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 L l l r tV C'_cyt Lt 4'1 c4 4 V' •rkl E'_ ✓C )C (9 ctl G v Alt v! hhinelol 12 4 97 9:02 AAI f' f'Ltdr -A TYPE—S TYPE—A TYPE—BTYPE--C --- -- _ T TYPE\ C 52., 30„ 22„ 192,. 66" - 60" 45 60" 68 76.. 43" IDTH 51�" WIDTH 51 WIDTH 55%" WIDTH 55%" FINISHED BASEMENT FLOOR 2" ABOVE BASE OF CASTI TYPE—D TYPE—E TYPE—F ,� 22" 22" 30" 22" 18„ 2 86" 9 2" 104" 84" 93" 101" WIDTH 551" WIDTH 58" WIDTH 58" FINISHED BASEMENT FLOOR 2" ABOVE BASE OF CASTING 18" MIN S — 72„ 40" A,B,C,D = 96" MAX E F 120 " 12 FOUNDATION COATING NOTES: I------84" -� 1. KEEP FOUNDATION SEALER A MINIMUM OF 12" FROM OPENING. 60' 2. POUR A MINIMUM OF A 11%" STEP IN BULKHEAD OPENING AS SHOWN. EXCAVATION REQUIRED 3. KEEP A MINIMUM OF 18" FROM FOUNDATION CORNER. 4. ROOF DRAINAGE SHOULD BE DIVERTED AWAY FROM ' '- BULKHEAD OPENING. 5. PERIMETER DRAINAGE RECOMMENDED. ISeMEA 6. BACK FILL SHOULD BE CLEAN GRAVEL WELL COMPACTED. CONCRETE PRODUCTS, INC. 7. HOW TO ORDER: — DETERMINE DIMENSION FROM.TOP OF FOOTING TO BULKHEAD INSTALLATION PROPOSED FINISHED GRADE. REFER TO TYPES AVAILABLE AND SELECT SIZE TO ASSURE TOP OF RECOMMENDATIONS STAIRWELL WILL BE 2" TO 6" ABOVE FINISHED GRADE. P.O. BOX 520 — 773 SALEM ST., ROUTE 62 NO. WILMINGTON, MA 01887 TEL. (978) 658-2645 FAX. (978) 658=0541 PAGE A5 NORTH 01VAM . 0 fAndover 0 0% A o dover, Mass.,` COCHIC HE WICK AERATED PP�\yt5 � �S Gt"♦ BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES Nelr_w Ch,4,64-v BUILDING INSPECTOR THAT Foundation has permission to erect................ p p� �O� ......... buildin��14014 0 yvtczxmo� Trr/4e e... Rough . ... . to be occupied as......../ 14 •./Y A7 AW /`*A /`...1. �r.... v himney .. ..... .......... ........................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Ins pec 'on, Alteration and C nstruction of Buildings in the Town of North Andover. 4 g PLUMBING INSPECTOR 8 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ELECTRICAL INSPECTOR T S � 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. I