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HomeMy WebLinkAboutMiscellaneous - 50 MARBLEHEAD STREET 4/30/2018 (3) 50 MARBLEHEAD STREET 0'21 210/008.0-0013-0000.0 i 4 ' Date.. . �.� e'q... .. A- nT J O 0 , M ,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION AC MUSE This certifies that . . ..�..~. . .. :. ... .. . . . ..::jJ . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . .°. . . ..t. .%�v . . . . . . . . . . . . . . . . . . . . at .`. . . . . . ... .�. .. . . . . . . . . . . . . .Q` North Andover, Mass. Feb . .'/ . . Lic. No.X3Gl/. . /�� . . . . . . . . G7CS INSPE T�R pp Check# 6816 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: I\l e WOW' MA. Date: Permit# 4 dp'6 �! Building Location;„��d(`��C:h� v Owners Name: -1�� We�57� n, lc Type of Occupancy: Commercial ❑ Educational ❑ Industrial Institutional E] Residential New: ❑ Alteration: E] Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES vi Z 1w- N U) 0 x D W O N = to N m x O� 0 J U W ~ N O W W 0 Z Z 0 H W IXWp Q I=— MCI a H O W X > w Z m C9 ~ W to O Q w x a F- W w z 9 x I- a co U Lu I— p Lu > V W Z O J ~ H O Z J a u_ Tin W I— W W O W j Q W W W m W O Z O W Z > Z Q Fx- U 0 0 LL t9 0 x x J O a 91 00:1 1-1 > > > O SUB BSMT. BASEMENT 1 FLOOR -2w-FLOOR 3 FLOOR 4 FLOOR 5 THFLOOR 6 FLOOR --i'FLOOR 8 FLOOR /,� l( Check One Only Certificate# Installing Company Name: 1y un P119� 6)ALi ❑Corporation Address:1 5 WA 6 • City/Town: State: ❑ �9�-I � Partnership Business Tel: 178-G, 1" 3 j 0 Fax:�7y (1LLt /Company P Y Name of Licensed Plumber/Gas Fitter: r IN URANCE COVERAGE: 1 have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes, please in Cate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the mit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing and Chapter 142 t ' neral Laws. TV0e of License: BY M Plumber Title QGas Fitter Signature of Licensed Plumber/Gas Fitter paster / City/Town [-]Journeyman License Number:- B (Q APPROVED OFFICE USE ONLY ❑ LP Installer a Date.� ..... ...... HOR7M -14, TOWN TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CMUSEt This certifies that . _ C:�........ ..C. :,.Pf. .h�.,.................................... has permission to perform .-�- `�: .:.- ! .. -.....!'s .c......... wiring in the building of........... .... .: -? -fi i ` at �< '�-�%+ �... -f-�% ",North Andover,Mass. ................... ............. ..-P -.... t Fee .... ..... Lic.No- .� _ f .. U� ::j...:r ..... .. ELECTRICAL INSPECTOR Check N 7046 r. Commonwealth of Massachusetts Official Use only ' Permit No. / Department of Fire Services r , Occupancy and Fee Checkedy� BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: // -7-- 0 6 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) 6y 6r2 Itl6egle McIO -, 7' Owner or Tenant 8��f ,2 ytlerfL 1 wc` Telephone No??.X-675C- Owner's Address &Ae 147ve ^V 50 V /VF{ 03r// Is this permit in conjunction withna building permit? Yes No [:] (Check Appropriate Box) Purpose of Building �.eStcxL&-!-Zc-1 Utility Authorization No. Existing Service x0-0 Amps 1,;70/c2g0Volts 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: Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting 92, rnd. rnd. Battery Units No.of Receptacle Outlets '(� No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches & No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No. of Waste Disposers Heat um Number Tons KW No. of elf-Contained Totals Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municippi ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No. of atero.o No.of � W Data Wiring: Heaters KW Signs ; '- Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Moto�s Total HP Telecom in u nications Wiring. No.of Devices or Equivalent " OTHER: L Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 5�• (When required by municipal policy.) Work to Start: 11-7- 6 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived b the owner, no permit for th y p e 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 covera e is in force,and has exhibited proof of same to the permit issuing office. A CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. 3� FIRM NAME: ,e LIC. NO.: Licensee: &I puy Ott fled- Signature LIC. NO.: (If applicable, enter "exem "in� t�lj�e licens number line.) ✓�A Bus.Tel. No..1orf 961-$8•/& Address: / L7'�1 �ftE-IL vim% �d`AQFG>1P� _ Alt.Tel. No.: *Security System Contractor License required for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: SignatureturaTelephone No. --- :t �Z ^ t3 . Or 5� • Date.�.�G-D P......... pORT1� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �'ss�cNusE� Thiscertifies that ............................................................................................. ' has permission to perform . wiring in the building of.2 ...................................................... at x.... -S...74................................................. :.... ........... � North Andover,Mass. Fee .............. Lic.NoF!.A � ELECTRICALINSPE R% Check # 8982 Commonwealth of Massachusetts7Occupancy Official Use Only Department of Fire Services � �. BOARD OF FIRE PREVENTION REGULATIONS nd Fee Checked /r3G(o [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Cod MEC),527 Cp WORK OR I� (PLEA SEPRINTININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER o By this application the undersignedgives To the Inspector of Wires: ves notice of his or her intention to perform the el trical work described below. Location(Street&Number) -!� Owner or Tenant 1jch2R y Owner's Address S � Telephone No. Is this permit in conjunction with a building permit? Yes Purpose of Building NO ❑ (Check Appropriate Bog) Utility Authorization No. Existing Service Amps _ / _Volts Overhead Undgrd No.of Meters New Service Amps _____L_Volts Overhead Undgrd No,of Meters Number of Feeders and Ampacity" Location and Nature of Proposed Electrical Work: _�� ° ► rt � � n � ,� 5 yPa Completion o the ollowin table may be waived b the Ins . e .- us ector of Wires. No.of Recessed Luminaires Noof CilSNo,of p.(Paddle)Fans Transformers Total . No.of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No.of Luminaires Swimming pool Above In_ o.o mergency jg g No.of Receptacle Outlets d d Batte Units No.of oil Burners FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners No..of Detection and No.of RangesInitis • Devices No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat P =37N,.. Tons KW_ No.of Self-Contained Deteetion/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal =� No.of Dryers Heatin A Connection ❑ other Heating Appliances KW Security Systems; No.of Water No.of BallNo.of Devices or E uivalent Si s B Heaters KWNo., of Data Wiring: Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of MotorsTotal HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Estimated Value—of Electrical Work: ` aach additional detail if desired, oras required by the Inspector of Wires. Work to Start 5 (When required by municipal policy.) —_ 5`– Q 9 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 y undersigned certifies that such coverage is in force,and has exhibited proof of sam the permit issuing office. CHECK ONE: INSURANCECK BOND ❑ OTHER I certify,under the pains and penalties o er u that the in❑ormaetion)n this'a pl FIRM NAME: f ry' pplacation is true and complete Licensee: LIC.NO.: I a licable, a ter"exem t"in the license umber line Signature LIC.NO.: d%-.5r (.f PP � p Address: r Bus,Tel.No.: d� P *Per M.G.L c. 147,s. 57-61,security work requires Dty Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Department a doles 'not Safehave,the liability Lic.No. required by law. By my signature below,I hereby waive this requirement I am the(check one) owner coverage normally Owner/Agent ❑ owner's a ent. Signature nerg Telephone No. PERMIT FEE: $ �� ,.. .� 4 f, 1 ,. The Common wealth of Massachusetts k� ! Department of Industrial Accidents Office of Investigations 600 Nwshington Street t 1, Boston, K4 02111 www_nzass.gov/dia . Workers' Compensation 1whrance Affidavit. Builders/Contractors/Eleetricians/Pinmhers Aaplicant Information Please Print Le-ably Nance (Business/Organization/individual): r c C Address: CitylState/Zip Q 2 i'1/ Dy7 Phone#: Are y an employer?Check the appropriate box: l.' am a employer with�_ 4, 111 am a general contractor and I Type of project(required): employees(full and/or part-time).* have lured the sub-contractors 6 ❑Naw construction 2.❑ I am.a.sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. [J Demolition working for me.in any capacity, workers' comp.insurance. [No workers comp. insurance 5. 9• Q Building addition ' p ❑ We are a corporation and its required.) officers have exercised their 10.Q Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions myself[Nonworkers'comp. c. 152, §1(4),and we have no 12.Q Roof repairs insurance re qufired t] .employees. [No workers' 131701comp. insurance required..] ;Any applicant that checks bo)f#I must also fill out the section below showing their workers'6om pettsation policy information Homeowners who submit this affidavit indicating they are doing an work and then hire outside contactors must submit a new affidavit indicating such. ?Contractors diet check this box must attached an additional shut showing the name of the sub-contactors and their wort ars'can p.policy information. I ant an employer that isProvi 09morkerscompensation insurance or a !O PPC- gelpy�is e a ' andjob site inform wion. f nF Y p hcY :/ Insurance Company Name: [ 1000 Policy#or Self-ms. Lie.#: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify u r e pains nd p trlties of perjury that the information provided above is true and correct Si tures Date: - �26 _ .eay 9 A Phone#: 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): I. Board of Health 2. Building Department 3.City/Town Cierk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#; Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp Ioyers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral.or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or airy 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 owneir-of a dwelling house having not more than three apartments and who resides therein,or time occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not: because of such employment bo 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 bnsiness or to construct buildings in the commonwealth for any applicant who has oot produced acceptable evidence..ok'compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor,any of its political subdivisions shall enter into any contract for the performance of public work umil acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority Applicants Please fill out the workers'compensation•affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of 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. lfan LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit The affidavit should be returned to the.city or town that the application for the permit or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please-call the Department at the numberlisted below. Self-insured companies should entertheir self-insurance-license number on the•appropriate line. 1' City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which A-ill be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under."Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: ° The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-7274900 ext 406 or 1-8.77-MASSAFE Fax 4 617-727-7749 i Revised 5-26-QS www.mass,gov/dia i ' Date.................................. NORT" TOWN OF NORTH ANDOVER -S p PERMIT FOR WIRING SA US -i Thiscertifies that ........ . ........ ...... ................................................................. has permission to perform $ wiring in the building of.... l.d?L ....... at.........©...`S .........! ��-.. . �/ ... ' . ,North Andover,Mass. .......... ' Lic.No. �Fee. / 2- ELECTRICAL INSPECTOR s Check # ` f 6931 :z PROFESSIONAL A P.O. sox ssa STRUCTURAL ENGINEERING • � �' E. HAMPSTEAD,NH 03826 LvTpq� DESIGN SERVICES (1503) 328.5540 M CII FAX (603)329-6406 STRUCTURAL RESIDENTIAL• E o.�' / Z•-1 9 A}C i Fc/sTNo ��Wpoq en, MA TITLE MVa VA%t t��� �1t,�fsS/p qL G\� EST .) JOB 3 N0 SUB JECT _s SHEET N0. DESIGNED $Y E -CHECKED BY DATE i 5T-aAv (FLE►�>t�� �►ToP -- �GXltT!N4 2x G. (L �Z �A&VLV_maf.r.� (m 7Wt� �fl AAr, +i Z..xt.ezo``oc., z G.G.��l1aG� Sb� rs e J►,�F �Le_L LAW �p � i,XISTI i.C,, �-r-I L 7 ,m J �C`'ICrILAI_ •ATTIC. SEGTtoI-� i� e 4 w PROFESSK}NAL P.O. BOX 958 \a4 A' 9�, STRUCTURAL ENGINEERING E. NAMPSTEAO, NH 03M SA Re . �� DESIGN SERVICES (603) 329-5540(6N 'L FAX Q3) 329-64M , L RESIDENTIALTITLE • ` _ n _ € EST .) SUBJECT � elf 4 cA 30$ J & z SHEET NO. DESIGNED BY DATECHECKED BY. DATE , s. s- r C+t6tv; ` <b✓ @'"t4_ VA � ^ k 6 t_t� ms's ;'7 ✓X18-a t.... Q.- -7 t=$t-i $ (ru CIE k" !°k- `t 6-Aft Commonwealth of Massachusetts Official Use only Permit No. 6131 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO TION) Date: City or Town of: N OP— 1�\ AO ' p U-ems To the In pec or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) �jn kD !�a M fte f-6-(r-KPa,�- C Owner or Tenant RU �(%�w Telephone No. 7,7G -67SF Owner's Address $ l.4.�r 6-o K-) "V 4 !( Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Gl( yU Utility Authorization No. 1 q7 6 6,-2 Co Existing Service -26 6 Amps /V /�2 KO Volts Overhead Undgrd❑ No.of Meters _1;Z New Service Amps /�(J la 90 Volts Overhead Undgrd ❑ No.of Meters y� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Move vl,k(z- S O&(C�( <, pc1�r cQ E Completion of of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil: No.o Total Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.o Detection and Initiating Devices No. of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No. of Waste Disposers Heat Pump Num er Tons KW o.of Self-Conta,iped Totals: I I Detection/Alertinji`Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other Connection No.of Dryers Heating Appliances Kms, Security Systems: No.of Devices or E uivalent No.of 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 Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical W rk: , 01D (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cover ge is in force,and has exhibited proof of same to the permit issuing office. . CHECK ONE: INSURANCE PT BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information this application is true and complete. FIRM NAME: LIC. NO.: i Licensee: o�G� y�. � 4 Signature L LIC. NO.: y-a0,93 (If applicable' r "exempt"in the license number line.) Bus.Tel. No.: Address: a� *—W" /#/,I- dit Vp2- Alt.Tel. No.:WP-YQ3 -?3040"7 *Security System Contractor License required for this work; if applicable,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, 1 hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. 5� 'S o� flA r Location � � !'�-- No. Date &ORTPI TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ •�� Building/Frame Permit Fee $ .� Foundation Permit Fee $ s�CMU Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL ) $ �= CRS{� ����--�� r��_-�-•____ Building Inspector i 3 '1 696/15/99 14:35 25.00 PAI) Div. Public Works Location ` /' �� r, ` `e No. ��— Date he NORTq TOWN OF NORTH ANDOVER ,. op Certificate of Occupancy $ 41 Building/Frame Permit Fee $ �•� Foundation Permit Fee $ CHUS Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ CAs � Buildi�Inspe�ctor 13169 Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD***"-****NORTH ANDD ER, MA �( NIAI'NO., J U LOT NO. 00 I 3 2. RECORD OF OWNERSIIIP DATE HOOK PAGE ZONE Still DIV. LOT NO. LOCATION PURPOSE:OF BUILDING Sriw e . -ev OWNER'S NANIE ice, p i p o r-r.o NO.OF STORIES SIZE OWNER'S ADDRESS S^© -5-: Meta-Pi i. E i-X1=,00 S: BASF.AIEN"L OR SLAB ARCHITECT'S NAME .. SIZE OF FLOOR TIMBERS 1 f 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW !NJ(o SIZE OF FOOTING k IS BUILDING ADDITION rJ NLATERIAL OF CIIININEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL.BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN NATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEIVER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTIICTIONS 3. PROPERTY INFORMATION LAND COST EST.BLDG.COST PACE L FILL OUT SECTIONS 1-3 EST.BLDG.COST PER SQ. FT. EST. BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERM IT NO. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS d. APPROVED IIY: �! PLANS MAST BE FILED AND APPROVED BY BUILDING INSPECTOR RIMMING INSPECTOR DATE.FILED l Q p OWNERS TEL# ./3 7 -,g r � CONTR.TELIi SIGNATURESIGNATUREOF OWNER OR AUTIIO{il"LED ACEN CONTR.LIC# FEE $ �- f II.I.C.# � v PERM IT GRANTE•D / (� 197 Revised 5/5/99 ,IN1 4 NORTfy 10NM OfL ®ve 011% DS �o�H dover, Mass A ., DRAT E D P �C� S Se 4 BOARD OF HEALTH PERM- I I TU Food/Kitchen Septic System ® r BUILDING INSPECTOR THISCERTIFIES THAT......111%... ............ ..0.... ....................................... ................. ...... ............ .......... Foundation has permission to eFt. .. �`�...1........ buildings an .... .®! ....... A. . �.�........%l._....... Rough 4. to be occupied as. .. .®. .®.. .............y`!*a e. �r�.......�..�..r`.°�..e. � ��.............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the appliccaation on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough cc PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL UNLESS CONSTRUCTI ST T Rough INSPECTOR AI! 3 � ............. ............... Service BUILDING INSPECTOR i` Final 41-413 Occupancy Permit Required to Occupy Building RougGAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Final h 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. • Town of North Andover NORTrl ' OFFICE OF 3? • • °'y° COMMUNITY DEVELOPMENT AND SERVICES t x 27 Charles Street North Andover, Massachusetts 01 845 X94°° WILLIAM J. SCOTT SSACHUSE Director (978)688-9531 Fax (978) 688-9542 In accordance with the provisions 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: AT-4.A wT-1 c- X0 11-r N wasT S' 5 Y 5r E-ms (Location of Facility) ignature of Permit Applicant 6- 7 - 99 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I� IIS . BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-95.10 PLANNING 688-9535 TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to " b registered contractors, building" be done tures which are adjacent to such residence or bu g y e9 structures 1 with certain exception, along with other requirements. Type of Work: sr� P �-e;0 C—A& Cost Address of Works"'-S"z 6- 497 O 51_0'7 Owner Name: Date of Permit Application: ro _ 7 " 99 I hereby certifythat: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. - X Job under $1,000 Date Building not owner-occupied X Owner pulling own permit Other (specify) Notice is hereby _given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above Property: Date ADwner Name t Location -74 r No. Date 8"I y! TOWN OF NORTH ANDOVE11 3 � `. Certificate of Occupancy $ _ Building/Frame Permit Fee $ —3 cMustt Foundation Permit Fee $ Other Permit Fee $ --------------- j � Sewer Connection Fee $ C— Water Connection Fee $ $ TOT .L _ �c�'lGcl� 9)( ` Building Inspector 4 0294 Div. Public Works �1IT NO. I APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 .a L-prAg 9�-, © � NO. X61.3 2 RECORD OF OWNERSHIP �DAT�IBOOK PAGE — ZONE SUB DIV. LOT NO. OCATION GJQ aI�r2FILEHaD cST/QEET PURPOSE OF BUILDING ��J21oV ��u y%l�, /Jc'� R O7WNER'S NAME �'•���nA/C��. NO. OF STORIES SIZE r/c�W NER'S ADDRESS 5a MARSI-1 /Y�J EHEA/` QE.E:7- BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST !/�•2 3RD ,,BUILDER'S NAME iSPAN -- DISTANCE TO NEAREST BUILDING y�I L� � DIMENSIONS OF SILLS -_- DISTANCE FROM STREET ((vv'�"—� POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION rHICKNESS i IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION �'Y> IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yes IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY 1• C) IS BUILDING CONNECTED TO TOWN SEWER l� IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES jo"T. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING,INSPECTOR r DATE FILED �lr�1� r �7 � � ���� ���LAo MUILDINQ INSP[CTOR IGNATURE OF OWNER OR AUTHORIZED AGENT FEE OWNER TEL.# PERMIT GRANTED G CONTR.TEL.# 4 19 CONTR.LIC.# H.I.C.# d-A'$& BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY SiOR1E5 THIS SECTION MUST SHOW EXACT DIMENSI6NS�OF Lor AND'DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUI'LDI'NGS. WITH. PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION ." .'*�• °�- _ -- 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 2 13 ; CONCRETE BL K. —{ PINE BRICK OR STONE HARDW D —_ —— PIERS PLASTER _ DRY VJALI _ _ _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. 8 M AREA _ 1/1 1/1 '/ FIN. ATTIC AREA _ N_O 8 M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY �_ STUCCO ON FRAME BRICK ON MASONRY- ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I_ POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ f WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ c TAR & GRAVEL STALL SHOWER - 1. 'r�Fa ♦ __ f Y°' ROLL ROOFING MODERN FIXTURES ` TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd . _ ELECTRIC 1st i 3rd. I NO HEATING AORTF-� JF Town of O� ®Ver � ' T1% No. h 0 _�-: K rdover, Mass., rnr .cc �9 19A COCMICMEWICK ORATED Pl?�' C� SF BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............................. ....5.&iq......ryl.ao..N4=.&..................................................................... Foundation has permission to ere ....p1ZV'--............. buildings on ..... Rough to be occupied as .�f "1 .. 0,! h��".... ... Itf 7 .LL ..IV. " ..... .....�...! !.�' I ...:.. chimney provided that the person accepting this ped it shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUC.T-IO .I.C�i�TS ELECTRICAL INSPECTOR Rough ..............................`.................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or. Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det.