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Miscellaneous - 51 FOXHILL ROAD 4/30/2018
51 FOXHILL ROAD 210/037.C-0038-0000.0 0 9 7 4 4 Date _ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . A il, +.vv ,.o . . . ..d*. . . . . . . . . . . has permission to perform . .13.x?C k.f l u w. . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of. . .3.(vC,N k �-. . . . . . . . . . . . . . . . at . . 5-J. . .lr-Pi(. .�.�. . . . . . . . . . . . . . ,North A ver, Mass. Fee . 2z z .LULic. No. . . . U . . . . . . . . . . . . . . . PLUMBING INSPE OR Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY o ., MA DATE � /3_ PERMIT# JC JOBSITE ADDRESSE=� [�,�/ OWNER'S NAME P OWNER ADDRESS TEL — IFAX I' TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL RESIDENTIAL([]� PRINT CLEARLY NEW: ] RENOVATION:Ell REPLACEMENT: 20" PLANS SUBMITTED: YES El Non FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ...__,__� __! . _ i .�( i [ -_._....,._f _..._.J _ ___i ___...I ' CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM -'- - DEDICATED GAS/OU-SAND SYSTEM DEDICATED GREASE SYSTEM ._. .71 _._. i _...._._I -_._..._.! _D DEDICATED GRAY WATER SYSTEMI I - I ____-_..► _ ._ ( I __.._.. __ ! __-- _ DEDICATED WATER RECYCLE SYSTEM i __... ! ..._..__{ I ...._.._! _._.-.I DISHWASHER I ______i F______! _.:.._._._! DRINKING FOUNTAIN ----.-._. .__.. ! .,_..._...I FOOD DISPOSER T --! FLOOR/AREA DRAIN ! _µ_____i _._.__..t ......___i ._........_` ._.___-� ...- INTERCEPTOR INTERIOR ! _..-....__i _-.,......_f I ....___.-_1 �i KITCHENSINK �.( _.1 __._..._f _..-..__ ...E ..._._...._-...I .__......__..( .._._......__I _._..___-{ ______6 _._.__._._I _-_._...__I __...__f _ .-__i _....._.-...� LAVATORY �._E ROOF DRAIN _ { __.._._'i §E-IOWERSTALL _..__.__I SERVICE/MOP SINK _.._____) __--...__I _._.._..___t .__. ! ( ., ( ..___._....I .-.-,_..-_ F-7_. TOILET. URINAL _.__.__I __._-! --_-__� .____...I T§ ...... l .. -i .__...._� _...I _.._( _ ' ' ...__.__ c E ----- ...._._! -.. WASHING MACHINE CONNECTION WATER HEATER ALL TYPES d( t WATER PIPING _.! _ ' I .-.._._.1 i _-- IE-11 ER f OTH ( INSURANCE COVERAGE: O have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 'NO �] OF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2r OTHER TYPE OF INDEMNITY BOND 0 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 Ej AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will bei m nc�e wit II Pertin t provi n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ����'�,`%J- PLUMBER'S NAME _ 5'YI" ,��1-w„�-..�_ (LICENSE# b�U _ SIGNATURE MPO JP Fil CORPORATION EdW�PARTNERSHIP]# ?LLC i COMPANY NAME �� �� p f € ADDRESS P 1 i�p yc J�� ll CITY'hy. � � � ----__�.._.-------- -- - U"v-�� ;STATE ;ij 1 ZIP ��! y.� TEL z✓v FAX Shy- c_ CELL 7�EMAIL y I 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 �%�L►7 // / y/f S k The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Uf www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El 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. F1 Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12:❑Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they Lire doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:, Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 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 certtfy under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officdal. 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#: i= I f 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" ..e er y person 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 shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,IIIA,02111 Tel,#617-727-4900 oxt 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 wWw-mass,gov/dia Date... ...................... NORTH ; TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .: - ' ` :.... ... ? ...... ' 1 . has permission to perform - - wiring.in the building of ........................... !�........:1... �" .... ............ .North Andover,Mass. Fee 22...... ..�...... ............ .. .............................. t ELECfRICALINSPECTOR G ? Check # k. 8779 Y (fommonWeaR o f Maeeae"tb Official Use Only I cc� Permit No. 2eparlmord o f Sire Servica9 Occupancy and Fee Checked BOARD OF FIRE PREVE9. NTION REGULATIONS (Rev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:_ Z-? p City or Town of: Wc-� 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) 15-4, Owner or Tenant S u el-4 , d Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building. Utility Authorization No, Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Ins ector of Wires No. of Recessed LuminairesNo.of CeU.-Susp.(Paddle)Fans o. o otal Transformers KVA No, of Luminalre Outlets No.of Hot Tubs Generators KVA No. of Luminai(es " Swimming Pool Above ❑ n- ❑ o, o Emergency Lighting rnd. rnd. Batte Units No. of Receptacle Outlets /Q No.of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo.of Cas Burners o.o etection an 7 Initiating Devices No. of Ranges No.of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat um u.m•••er ons o. o e - o n t a I n e Totals:71 1 J' Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local[] Municipal El Other Connection No. of Dryers Heating Appliances KW ecurtty :" No.of Deevicevice s or Equivalent No. of Water KW o. o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or F.c uivulent No. Hydromussuge Bathtubs No. of Motors Total HP c ecornmuniciitiuns Wiring: No.of Devices or Equivalent �- OTHER: Attach additional detail if desired, or as required by the Inspeciur of{Vires Estimated Value of Electrical Work: (When required by municipal policy.) Work to Stan: ZZ,5U j 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 s in force,and has exhibited proof of same to the permit issuing office. 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. FIRM NAME: ,04&11.D 60<, �-/,cf C' LIC.NO.: Licensee: ,�1//D hf4�G,�12 Signature LIC. NO.: (If applicable, enter "exempt"in the license number line.) Bus. Tel. NoY7g 6 Y2 626Z Address: g? L3E�y"iZ Sr l(/yiP1"fi/ f�.ypUt/t' 2%4a/8Y3 Alt.Tel. No.97,r- 375-:LZ 3�1 'Per M.G.L. c. 147, s. 57-61,security work requires Department of Public Safety"S"License: Lic. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signarure below, I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: 3l/' i �.� �� ` � ��� Com? � � •�- k r ,� ,�\ '. <. Date..... 'If NORTp 1 ' TOWN OF NORTH ANDOVER PERMIT FOR WIRING COW :i This certifies that l/�/ cT�L has permission to perform ..�� I/v EAA44;�Oal' wiring in the building of....... .8 UC�/ d G.��—...........:.......................... at...... .............................. .... ................ lj/..�.. �.....................�. ,North Andover,Mass. „t Fee..:J.. L.r.. Lic.No..... ELECTRICAL INSPECTOR f y. ,2 > a' Check tt /5- 8501 CommoneveaGlk olaeear�iusells Official Use Only Permit No. 2parlm rd o`�ire services J6Q Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: /(/ 1040-t, — To thelnsp ctor of Wires. By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) t Owner or Tenant t9'1 e- 0Soc' ,IS"° �1��1t��� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building C-J,1,+6&F- c-T Utility Authorization No. Existing Service Amps ! Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /7'P SC- Completion of the following table may be waived by the Inspector of Wires. No.of Total No, of Recessed Luminaires No. of Ced.-Susp.(Paddle) Fans Transformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaire! Swimming Pool A ove ❑ n- ❑ o.o mergency ig ing rnd. rnd. Bat-tery Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No. of Zones No, of Switches No.of Gas Burners No---.-of etection an Initiating Devices Total No.of Ranges No. of Air Cond, Tons No.of Alerting Devices No.of Waste Disposers eatum um er ons o. o e - ontaine Totals ............................................................................. Detection/Alertin Devices No, of Dishwashers Space/Area Heating KW Local❑ un cipal ❑ Other Connection No. of Dryers Heating Appliances KWSecurity Systems:* No,of Devices or Equivalent No. of Water KW o. o o. of 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: s Attach additional detail if desired, or as required bt•the Inspector of Wires, d Estimated Value o Electrical Work: (When required by municipal policy.) Work to Start: &® 60' 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 a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ND ❑ OTHER ❑ (Specify) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: g104V E6�4f-r,2IC14L &Q7Y,-4C-7-,14!t, LIC. NO,: 11/,63=+ Licensee: /-14LIlD m4e C,.-ice Signature LIC, NO,: (If applicable, enter "exempt"in the license number line.) Bus. Tel, No,:47t?-6$2 -6262- Address: $`7 do-emaur 677^ Alae7y r4�uDoc/t-*Q o4 OlPJs Alt,Tel. No.:97f 375-5.73z/ 'Per M.G.L. c. 147, s. 57-61,security work requires Department of Public Safety"S"License: Lic. No. 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 Signature Telephone No. PERMIT FEE: S I AUG-16-2005 05:28 AM KELLYCASEY 978 937 1816 P. 01 ...•.............._................ ............................., ...•. ..... _.�_�....�.t,......J..,...... .W_.J.i._��...__........._ FAX COVER PAGE From: Kelly Casey 700 Robbins Ave Unit 3 Dracut,Masa 01876 Fax 978-937-1816 Phone 978-6974453 To: Electrical inspector 27 Charles St. North Andover,Maes 01845 Tel 978-688-9545 Fax 978-688.9542 Pages to follow:0 Dear Electrical Inspector, All work at 51 Fox Hill Rd.is complete. The customer will be calling you to schedule an appointment for inspection. The customer is Sue Bucholz and her number is 978-687- 8870. Sincerely, Kelly Cas Location ,/ No. Date AORT#q TOWN OF NORTH ANDOVER of F / 9 i i s Certificate of Occupancy $ ;�s'•••°•Eta Building/Frame Permit Fee $ Mus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ `— ,M Check #C ' i 17816 Building Inspec TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISII A ONE.OR TWO FAMILY DWELLING. BUILDING PERMIT NUMBER: O DATE ISSUED: —12 ` IM SIGNATURE: Building Commissioner/I ctor of Buildings Date '77 /7" SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: l � F�v 14- Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ZoningDisiric—t ProposedUse Lot Areas Front- e ft 1.6 BUILDING SETBACKS ft t Front Yard . Side Yard Rear Yard Required Provide Required Provided Required Provided Q 1.7 Water Supply I4.91.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zona 0 Municipal 0 On Site Disposal System. 0 J SECTION 2-.PROPERTY OWNERSHIP/AUTHORIZED AGENT rn e 2.=. Own r of Record Nr. e(Print) Address for Service Signature Telephone 2.2 Owner of Record: u chhnL, , Svc -4Ea�c p Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: %t, _ \� �.b ,7i J License Number r Address S [ -1 Zo , Expiration Date re Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Q Q Company Name / u 3 O.3 Registration Number Address © - �16 Expiration Date re Telephone G) r9 SECTION 4-WpRKERS COMPENSATION(AG-L. C 152 § 25c(6) Workers Compensation Insurance affidavit must lie completed and.submitted'.with this:application. Failure to provide this affidavit will result in the denial of the issuance of the buildin rmit. Si ned affidavit Attached Yes....... No.......u SECTION 5 Descri tion of pro wed Work check all a licable New Construction 0 Existing Building 0 Repair(s) Alterations(s) Addition p Accessory Bldg. ❑ Demolition ❑ Other 0 SpecifyF Nell Brief Description of Pro osed Work: AJSECTION 6-ESTIMATED CONSTRUCTION COSTS It `. Esfimated'Cost(Dollar)to be Com feted b etniit a 4 1. Building licanIt .- �� e O (a) Building Permit Fee 2 Electrical '' Multi lier (b) Estimated Total Cost of 3 Plumbin Construction 4 Mechanical HVAC Building Pernut fee 'x.(b) 5 Fire Protection 6 Total 1+2+3+4+5 Check,Number SECTION 7a OWNER AUTHORIZATION TO 13E COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT `u I, as Owner/Authorized Agent of subject property Hereby authorize My behalf,in all matters relative to work authorized by this building permit application, to act on Si nature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date .property ,aAuthorized Agent of subject Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. g 1<F l� Prin e Si ire of er/A ent Date t NO. OF STORIES SIZE BASEMENT 0R SLAB SIZE OF FLOOR TIMBERS l' NO2 SPAN 3 DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMFNSIONS OF GIRDERS ffE1GFIT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUQ.DING CONNECTED TO NATURAL GAS LINE i I NORTH Town of ��... No. - LAKE over, Mass., co_..C.." S RATED p? BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... .... ........ .... ........ .�........ ............. ... ...1..1...1...1. Foundation has permission to erect........................................ buildi n ....../....... .......... ...........!1f .'s."44&...... ....... Rough g t0 be Occupied as Chimney .............. . . . ................... 111 . . . ................ ......................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO 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. The Commonwealth of Massachusetts Department of Industrial Accidents Offieeof/ayestigalfons 600 Washington Street Boston Mass. 02111 Workers' Compensation Insurance Affidavit can ''tn of matron: a w >r .. ease;yIZ ea1:111T M t lip 1111111 2 t t��'w: location,,: I/� A V� city N �7Nd O lJ£✓L ��'� t:hone# / 72 6 ❑ I am a homeowner performing all work myself. p/1 am a sole proprietor and have no one working in any capacity nm LTA Sqf .e <3 ❑ I am an employer providing workers' compensation for my employees working on this job. co 12iny name 77. address': phone# insurance co. otic # ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: a'dd'ress: In ;n:.*:::::::::::: insurance co. oley.># IAII com an. n m . address. phone g. tuunince,c ON # 'A7^r A dditi nal hee('i e�essarr�< i°, �.� Failure to secure coverage;is required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. t understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the ns and penalties of perjury that the information provided above is true and correct. Signature Date Print name i��.�� ..�? CGP 1. .._.. . .. , .. . .._.._•._. ....._. . Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license q _._.._. nBuilding Department Q check if immediate response is required QLicensinkBoard QSelectmen's Office contact person: ❑Health Department phone#; Other (revised 3/95 PIA) "' - J�• r 1e 1. i 7— �O�IYU/920/ZCl/PQAA�L"�a.�(�U,W/IQ�%AA.OYGL4 Y$ BOARD OF BUILDING REGULATIONS . , Lic'e.nse: CONSTRUCTION SUPERVISOR i. Number eM, 058245 ' + �•t BirtFidate03/247!1!943 sExpi t,',03l24/20.06 Tr.no: 29031 - Restricted X00 �'� � �` KENNETH B:KEEN, 0 21 HEWITT AVE N ANDOVER; MA 01845 AAtI191-10 mis oner i y, s v+'!7 — i ✓!LE,1�J04I7�O)2I.i/ O�✓l�GC7.00p�itU6P.�d ��_ Board-of wlding;�Regulations and-Standards ' HOME4MPROVWMENTCONTRACT ^72 Registration'o, 108383 Expi on"1f8/2006 � �� T e .=Dl3A'�' r ;`V, i- KE€N CONSTRU(> zIO�SC© r }i< Kenjneth Keen �, 21 Hewrtt Ave \ � p„ No:Andover,MA 01845 rv' Administrator. KEEN;COl®1STRITC-ION CG. 21'HEWITT AVE. N. ANDOVER MA 01845 {978,)691=52.01 Buchholz, Sue.&Eric 5:1 ]Fox Hill Rd. N. Andover` 1VIA 01845 f (978)>687-887.0 Contract#41632— Appendix A;:Revision l Date:l0/17/04 Kitchen Remodel: Remove& dispose of existing cabinets Remove closetin kitchen- -and-wall between kitchen-and dining room • Supply& install header betweenkitchen:and dining room to approx 8',opening Supply& install header between kitchen 4and den to create '%z.wall:(approx 8' opening] • Remove wallboard on walls and ceilingin existing kitchen Supply& install two double casement windows in kitchen•area(Pella architectural series classic with clad ext:, unfinished.Poplar interior and elampagne hardware) approx. 42" x Supply,& install insulation-and vapor barrier (if necessary..) i-n exterior walls Supply'A install blueboard on walls and�ceiling and skimcoat plaster to smooth finish • Supply'& install trim'on wndows;;doors and base to match existing(paint grade} • Supply& install trim and siding on exterior to:inatch existinb \ r • Supply';&install customer-selected,5 V?Brazilian Cherry prefiiiished hardwood` flooring in kitchen only"(approx. 250 sq. ft). _ - • Patch hardwood in hallway and dining room as'best possible • Paint walls; ceiling and trim in kitchen(2 coat finish; 2 neutral colors} • Pai. exterior of nevjr trim and siding.with customer supplied paint (as soon as possible; weatherpermitting) - • Install customer supplied cabinets,as per drawings from Dracut Kitchen &Bath(including all molding) Supply& install customer selected ceramic file backsplash from National Tile (6'x 6'with 8=10 deco tiles)(standard installation included; diagonal installation will be quoted:by installer,-?no more than $20.0.00 extra) Install customer supplied appliances Electricat, Remove necessary wiring for demolition • Supply.&.install eight recessed light fixtures in ceiling • Upgrade electrical outlets and switching to code nn kitchen 1 KEEN CONSTRUCTION Co. 21 FIEWI'TT AVE. N. AND(IVER, �A 0 . 45 (978) 691-5201 Plunibmg: Remove baseboard heat in kitchen a Relocate.gas fine to new stove location Supply& install new plumbing and customer selected fixtures from Peabody'Supply Supply& install toe kick heater on existing zone Total Price $36;137.00 (thirty""six thousand one undred thin' seven dollars Y ). Price does not'include:cost of permits, painting of exterior, dining room or den, cabinets, counters, or refinishing existing hardwood fl A(1`:extras o paid in full upon ordering. Payment,schedule $2000 00 d&wn to order, windows 100 0 00: $ due u: ' _ ,pon:signing,-con tract $6000.00 due the first day of work $4000.00 due when windows are installed VMO'.00 due when kitchen is demolished $3000.00 'due when rough electrical i complete $3000.00 due when rough plumbing is complete' $3000.00 duewhen blueboard is hung $3000.00,due when plastering is complete $3000.00 due when:hardwood floor is delivered $4000.00 due when cabinets are installed $21.37.00 due-upon completion of contracted work A 14 us o r Robert A. Keen bate'. Date " 1632 KEEN CONSTRUCTION CO. in&-ap 21 HEWITT AVENUE PROPOSAL 14�0 NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978)682-3231 specifically exempt from registration by Provisions of Chapter 142A of the general laws;must be registered with Submittedi the Commonwealth :of Massachusetts. Inquiries about To: ..I � .. Fr.t_ ._..... . registration and .status should be made to the Director, } � `� Home Improvement Contract.Registration,One Ashburton .� _'_ _ 4 .1! `.. _._ _ Place,Room 1301, Boston, MA 02108 (617) 727-8598. n ItOwners who secure their own construction related G�VE� r �'Y f d 'i" permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. F.I.D.N0. MA. H.I.C. 108383 04-325-8052 > C/S = Customer Supplied S + I --.Supply+ Install We hereby submit specifications and estimates for work to be performed and materials to:be used: _. ... ......-...... .. 512 e __.__.__., . .... _ __... ........... _-----------._____ ._ ___. _ !I I I .... ___ _..- ____..m.._ ---- I > Construction related permits: .............................................................•:.....,..........,....................................................:.........,..,......,..... WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall-be free from defects in materials and workmanship for a period of following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contracto,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of 1 l .. ,t/I: tl r Ly.P y --d 1, 7 dollars($ Payment to be rrtade as ollows: ($ ) upon signing Contract; KENNETH B. KEEN Name of Contractor/Designated Registrant % ($ uporrc mp 11,14- j ) 21 HEWITT AVE. ^ p - Street Address $ u�o co ple jtof N. ANDOVER, MA 01845 City/State I� be ade forthwith upon (978) 691-5201 (978) 682-3231. r )) c pletion of work under this contract. Phone Fax Notice..oi'M-,agreement-jorl home improvement.contracting >down payment(advance,deposit) of more than one-third of:Ike total contract price Name Sal sma" f or the total amount of all deposits,or.payments which the contractor must make, in advance, to order and/or.otherwise obtain delivery of special order materials and A ho sgnature ,I' - equipmenf;whichever amount is greater. Note: This proposal maybe witndra!T by us if not accepted within days. Acceptance of-Proposal -I have read both.sides of this document and all attached documents and'accept the prices,specifications and conditions stated. understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of .this transaction. Cancellation must be done in writing. DO NOT/SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. t Signature, G L. ' togl9 nature Date IMPO:RTANT'INFORMATION ON BACK s:x u`f"�.iw' . .. - M ".�e .> �. Date.... :. ..4...... %ORTH � i TOWN OF NORTH ANDOVER 3? e q e OL PERMIT FOR WIRING �,SSAGMU S � - 'Y This certifies that ...:.. ... ` has permission to perform .. wiring in th building of � ir,�,e. . ....... ....w........ f at. r.... ..... ...!'. :................... ............ .North Andover,Mass. � Fee...'7 }:. .... Lic.No.37d& .... �. •......... ELECTRICALINSACTOR Check # _-� Commonwealth of Massae husetts Official Use Only 1 U Department of Fire S rvices Permit No. 0 BOARD OF FIRE PREVENTION EGULATIONS Occupancy and Fee Checked r [Rev. 11/991 leave blank APPLICATION FOR PERM[ TO PERFORM ELECTRICAL WORK All work to be performed in accordance ith the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE Al' INFO -4 TION) Date: 5/25/2005 City or Town of: North An overfA/f To the Inspector of Wires: ' By this application the undersigned gives no ce o his or her intention to perform the electrical work described below. Location(Street&Number) 51 Foxhill R Owner or Tenant Sue Buchholz V Telephone No.978-687-8870 Owner's Address Same Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install additional outlet in master bath. Install 2 cabinet outlets in built ins in living room Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I 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 Pum Number Tons KW No.of Self-Contained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No.of No.of t KW Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) On File Feb/2006 (Expiration Date) Estimated Value of Electrical Work: /2 5 0/2005 (When required by municipal policy.) ) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey Signature LIC.NO.: 37200 (If applicable,enter "exempt"in the license number line) Bus.Tel.No.: 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut Mass 01826 Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally l required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. f Owner/Agent / Signature Telephone No. FPERMIT FEE. $40.00 if 47vf L Location � � �v ` _Z� J No. L>'=� Date 3 NORTH TOWN OF NORTH ANDOVER Of « o e,h 3? •_ - _•SOL 0 A " Certificate of Occupancy $ ss�croeMusE`� Building/Frame Permit Fee $ ` Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 2 Check # C � 16241 building Inspector } TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ,Q DATE ISSUED: a D M V 3 -`- SIGNAT"URE: AA Building Commissioner/inspector of Buildings Date SECTION 1-SITE INFORMATION . ` • 1 " 0 1.1 Property Address: 1.2 Assessors Map'and Parcel Number: a ) 0 Map Number Parcel Number 1.3 Zoning Information:' 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R aired Provided Q 1.7 Water Supply M.G.L.C.40. 54) 1.5. Mood Zone Information: 1.8 Sewerage Disposal System Public 0 Private ❑ Zone , Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2 P.ROPERTY•OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record (IcS Dz uEp rz., 1G Sl Name(Print) Address for Service Signature Telephone 7c 2.2 Owner of Record: 7 V Name Print Address for Service: z Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 4 O J O ` License Number z, Z LA-"; Address SExpiration Date re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ I 4F Company Name Registration Number I �r Address 1`t Expiration Date re Telephone I� 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..... SECTION 5 Description of Proposed Work check all applicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ ,• Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: a PC2 ya Se SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Coat(Dollar)to be Gin U E OX at � � cqmpleted by permit a licant a 1. Building 00 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a).X (b) 4 Mechanical HVAC / C 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 I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building penrnit application. Signature of Owner Date SECTIO/N 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ��C C i�h�E 11'► IR K E� IJ aseAAuthorized 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 Prin e Si ue of er/A ent Date NO..OF STORIES SIZE k, BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS IiEIGI1T OF FOUNDA17ION THICKNESS SIZE OF FOOTING X NIAT.ERLAL OF CHDXv EY IS BUILDING ON SOLID OR FILLED LAND 1S BUILDING CONNECTED TO.NATURAL GAS LINE I E / Town ® Andover TO :2� No. T'_ h 07 o� COCHIM0 lover, Mass., - ADRATED PCl PS` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT iy = �'.....�� ..e.0..�.�.,� .z 19C� O ................................... .. ........ ... .........I..�....... ...... Foundation has permission to erect.....rims.&A....... buildings on ....� ........ �.A.#.....i .... ..... Rough 7 to be occupied as........ .J -�. , �/V T ,�/`....�?�c.......�v� �/ � Chimney provided that the person accepting this permit shall In eve respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws re ting to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. .3 -7/3 9 ® 90 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT 1 EX IRES IN 6 MONTHS Final � UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough ....................... .... . ........ ........ ..... .......... Service QING 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. =, The Commonwealth of Massachusetts Irl , Department of Industrial Accidents �= iool i) On/ceof/nvestigat/oas 600 Washington Street a -z Boston,Mass. 02111 Workers' Compensation Insurance Affidavit A ltcant in orf' matron ..1"ease.:PIII al L Krf"J AJ location:_ city Alm N d o It ip,- MX . D / q•S/ phone#772 6 0 _!S�?—n C3 I am a homeowner performing all work myself. J;?l am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. „ company name: address: city phone# ur nce co. olic '# IILi 7 - «1 R--Y n I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comp;iny name. ' address: cites 'Rhone# insurance co i company name: address: city. ' h n e#. insurince co, Rohcy Attich additional shelf u if niss,ir� °� 4 r.' , < rL a t xM o Failure to secure coverage as required under Section 25A of NIG152 can leadr -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 forni of a STOP WORK ORDER And a fine of 5100.00 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 hereby certify under the in a penalties o perjury that the information provided above is true and correct. Signature Date __� — -Z-4n - 6 :_ Print name N/d EL�/`� - Phone# (5 official use only do not write in this area to be completed by city or town official city or town: permit/license# -Building Department ❑LicensingBoard '—"' j ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; -Other . devised 3105 PIA) I ' I ✓fie �anvrrearu a �iuclufde(t6 Ys� BOARD QF'B_IJILDIN'G..REGULATIONS '�License .CONSTRUCTION SUPERVISOR A a Number.CS 058245 , Birthdate:03/24/1943 (Expires03/24/2004 „Tr no" "20b2'1 -- ;Restricted; I KENNETWB KEEN i 21 HEWITTAVE N ANDOVER, MA OT-845 Admimstator. i "tc•ri^pct _ r.,a :--�-... '--....;�._.......:.—..:. -. .n,.,,,;�.;,.a,;,;K;:` ii � ✓lie -v�ahvnw�.uuea/�/� o�/�,aaaaolzccaefa .. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration 108383 'Expiratlion 8/1'812004 Type ;DBA KEEN CONSTRUCTION CO Kenneth -Keen 21 Hewift.Ave _ No Andover,MA 0184,5 ��� Adfu�n�strator 1„: ELECT OUT thPS) ly 66 z,8 Ac f zy' ! FF,.. -. \f 0 ;PF KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978) 691-5201 Buchholz, Sue &Eric 51 Foxhill Rd. N. Andover, MA 01845 (978) 687=8870 Contract#1607 ; Appendix A Date 3/12/03 Finish Basement: • Demolish existing partition walls in basement • Frame partition walls to create @ 840 sq. ft. of finished area • Unfinished closets will be created under stairs, near water meter, and near soil pipe • One finished closet will be created next to door into boiler room • Create 1/z walls at bottom of stairs • Insulate and install vapor barrier on all exterior walls • Install four vinyl hopper type windows • Install blueboard and skimcoat plaster on all walls to be finished • Install five 6-panel smooth hollow core masonite doors • Install trim on all doors, windows and trim to match existing • Encase exposed lally column with pine(eased edges) • Install 2'x 2' suspended ceiling throughout finished area • Paint walls,trim and doors (2 coat finish, 2 neutral colors) Electrical: • Install four fluorescent troffer light fixtures in ceiling • Install outlets and switching to code • Install one cable and one phone(Cat. 5 wiring) outlet • Move electrical panel if necessary • Install wiring for new zone on boiler Plumbing: • Install new zone on existing boiler • Install zone of heat in new finished area Price does not include cost ofermits or flooring. g Total Price: $19,000.00 (nineteen thousand dollars) i KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978)691-5201 Payment schedule: $1000.00 due upon signing contract $5300.00 due the first day of work $3000.00 due after framing is complete $3300.00 due when rough electrical &rough plumbing is complete $3000.00 due when walls are plastered $3400.00 due when contracted work is complete Customer Kenneth B. Keen Date Date Date.Y.-4 d-3........... s f ,4ORTH TOWN OF NORTH ANDOVER F A PERMIT FOR WIRING $A US Phis certifies that ......................................... �......:-.................................... -4as permission to perform..... ' wiring in the building of....... :: . 54.'-t. ..................................... at..... . ... ....? ...... ............................ ,North Andover,Mass. Llf Fee.:.:-'Z�..S.......... Lic.No t� ��....7a .. .................. EL CTRICALINSPECTTOR, Check # t� 4-429 TBECOADIONWE40Hup-m SmicuII,5 m Office Use only DEPARTAIENTOFPUBLICS IM Permit No. BOARD OFMEPREVEMIONRWULAT OAN527CMR 12.* Occupancy&Fees Checked APPZ.ICAT70NFOR PF�RMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUsm ELECTRICAL CODE,527 CMR 12:00 Date L/ (PLEASE PRINT 1N INK OR TYPE ALL INFORMATION) Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perfForm the e Qctrical w cribed below. Location(Street&Number) / I/( Owner or Tenant Owner's Address. Is this permit in conjunction with a building permit: Yes an No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service , Zoo Amps nits Overhead Underground No.of Meters New Service Amps / Volts Overhead Undergrou d No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures Swimming Pool Above Below Generators tEVAKVA . ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No-of Self Contained a Detection/Sounding Devices No.of Dryers, Heating Devices KW Local Municipal Other No.of Watv Heaters KW No.of Connections No.of Signs. Bailasis j No.Hydro Massage Tubs No.of Motors Total HP OTHER In raxeCaaage Ptast ant1othetetl warm cdlvlm�C,erl W Laws Iha%ea=atLiabtldyhstrattoePobcyadxiagCa Cor wcrilssuttba 4fivalat 'FS NO Iha�est iYiffidva5dp►oofof bthe09x:e YES �chai dYESindr thetypecby�g b ie&,:�wv�,7 Ro'" (PleaseSmif WadcbSl:$t,. / /—� 3 RtimadVahtec7edricalWadc:$ Signed Mir—&Pis ofpajtay. FWMNAME �7 ,�( IeNa Lim= /10,���� / Sigh h Lioa>SeNo Ad&ms a/i,f D 30 7 Bttsir"Td.Na 7 / ------- Alt.1&No. OWNER'SDVSCIRANCEWANFR;Iamativatethatthel a theinsucanoeoo etr sst>hs�r�alegtnvalattaste mec}byM�adaselLsGataalLavvs and�mysaemlhis pan�gapp?x�rnvv�dfis tecgtitgt�tt. (Please check one) Owner � Agent Telephone No. PERMIT FEE$ l The Commonwealth of Massachusetts Department of Industrial Accidents } Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City ��/ ��� Ul/ 1`71, Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity aI 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 thelirmposftn of criminal penalties of.a fine up to si,5w.00v andfor one years'imprisonments-welLas-cha4 maltiesin-theltxm-d a iDPYADRK_ORDEP and_afine-d-Csi w)-aAay--9a+nstme. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. !do hereby certify under the pains and pene/ties of perjury that the information provided above is true and carxect. Signature ✓ Date Print name C l/l Phone.# Official use only do not write in this area to be completed by city or town officio' City or Town Eumi7/Laerisincl. Building Dept []Check if immediate response is rie"qukid, Licensing Board p ` Seiectrndn s Office Contact person: Phone k Health Department El Other Date.................................. t �aORTM 1 ° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ........ _ U........./......�.. ........ .. ..... .... has permission to perform ....,..._.....;....ti.....:.........17.. :: ...:................................. wiring in the building of.. .....i . .. :.......�.......:...........�.................... r :... ...........................................North Andover,Mass. r Fee...f.= ...�...... Lic.No; 7--a ...... ... L� ......... ELECTRICAL INSPECTOR Check # 5484 Commonwealth of Massac U setts Official Use Only Department of Fire Se ies Permit No. BOARD OF FIRE PREVENTION GUOccupancy and Fee Checked [Rev. 11/991 (leave blank) APPLICATION FOR PERM TO PERFORM ELECTRICAL WORK All work to be performed in accordance th the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /;4, — L Oz City or Town of: 4aL- um 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/ ,� 641`4-L �-7, Owner or Tenant Silt qf f�{c AaC{../W La Z., Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers .KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets`d No.of Oil Burners FIRE ALARMS I No.of Zones No.of SwitchesIt/ No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges Total g No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pum I.N Tons KW No.of Self-Contained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW I Security Systems: No.of Devices or Equivalent No.of Water No.of No.of Heaters KW Data Wiring: Signs Ballasts f Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecot unications Wiring: l No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) On File Feb/ Estimated Value of Electrical Work: . (When required by municipal policy.) (Expiration Date) Work to Start: 2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains a d penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey SignatureLIC.NO.: 37200 (If applicable,enter "exempt"in the license number line.) Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Bus.Tel.No.:978-697-44 53 AIL i el.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally �( required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ Commonwealth of MIthe setts Official use only f Department of Fires Permit No. BOARD OF FIRE PREVENTILATIONS Occupancy and Fee Checked [Rev- 11/991 leave blank APPLICATION FOR PERMPERFORM ELECTRICAL WORK All work to be performed in accordancessachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:.,b? — L 0K City or Town of: A �e Vim To the Inspector o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) / )5v"X let"G-L 9 692, Owner or Tenant $&/egt fl� '641, ,41V 60 Z. Telephone No. Owner's Address 1519-AVII Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Fixtures «fNo.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Lighting Outlets No.of Hot TubsGenerators KVA No.of Lighting Fixtures 3 Swimming Pool Above ❑ n- No.of Emergency Lighting rnd. grnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiatin Devices No.of Ranges / No.of Air Cond. Tons l No.of Alerting Devices No.of Waste Disposers eat Pump .. umber ons No.of Self-Contained Totals: ............................................................................ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No.of No.of Heaters KW Signs Ballasts Data Wiring: Noeof Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Te eco�munications irmg: OTHER: Na of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) On File Feb/ (When required by municipal policy.) Estimated Value of Electrical Work: (Expiration Date) Work to Start: '/I U� Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains aildpenalties of perjury,that the information on this application is true and completes FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey Signature LIC.NO.: 37200 (If applicable,enter "exempt"in the license number line) Address: 700 Robbins Ave Unit 3 Dracut Mass 01826 _Bus.Tel.No• 978-697-445 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance overage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner Owner/Agent ❑owner's agent. Signature Telephone No. PERMIT FEE. $