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HomeMy WebLinkAboutMiscellaneous - 52 LISA LANE 4/30/2018 52 LISA LANE / 2101098.A-0038-0000.0 I i BUTTERWORTH & 01TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY P.O.BOX 8294 SALEM,MA 01971-8294 TEL. (978)741-5731 FAX (978)740-9109 claimskbutterworthotoole.com 05/06/2014 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Bl-ii]-ding Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/T-own Hall City/Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Wayne Guyer Address : .. 52 Lisa Lane North Andover, MA 01845 Policy No . : 2376307 Loss of. : 05/03/2014 Mold File or Claim No . : 47-0533 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. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. David Vincent Adjuster tea. Sls :� Member of National Association of Independent Insurance Adjusters Date17 MOR7N TOWN OF NORTH ANDOVER o n PERMIT FOR PLUMBING ,SSACMUS� This certifies that .1.� .�. . . `�. ! ! �� •'�'�C• • °L • has permission to perform �. . . ..�. ... . . . . . . . . . . . . . . plumbing in the buildings of . . '�. `..`. . . . . . . . . . . . . . . at . . .. . . . . . . . . . . . North Andover, Mass. Fee 3. Sa .Lic. No.. $17 3 . �. . . . . . . . .X.. PLUMBING INSPECTOfi Check 8378 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH AND OVER,MASSACHUSETTS S7'e�' --e-, Date Building Location �n t�S'd� �Owners Name � Permit c Q`L( # _ Amount 1 Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES Z rr, a a o soala�c - - Ra�vr . IST MOM zl�n�nai f 41aKDM 5Il3kIlXR s1 R OCR 7MFLOC tt -FT: 9fflHfM (Print•or type) Check one: Certificate Installing Company Name / �r/ /�GLl l� - F1 Corp. Address L k Y A,—1- _ Partner. v Business Telephone 9 7 (n. (� 7it7 [2-Firm/Co. Name ofLicensed Plumber: tJ Insurance Coverage: Indicate the Type of insurance coverage by checking the box: Liability insurance policy 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 o£the above three insurance Signature- \, Owner Agent E 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 andjealations performed un&r PerTepsued for this application will be in compliance with all pertinent provisions of theMas chus to P ing C e an apter 142 of the General Laws. By: ol LiGensealvfuliaour-0 Type of Plumbing License Title City/TownLi—cense Numoer Master Journeyman APPROVED(OFFICE USE ONLY r 1 The Comnzonweizlth of Massachusetts Department o f£radusti-ial _4ccadents Office of£-ivestigations 60.0 Washington Street BOStOI'Z, AL4 021II Www-Massgov/dia 'workers' Compensation Insurance Mfidavft: Builders/Contractors/Electricians/Plumbers Akn licant Tnfnrznafion Please Print Legibly Name(Business/Ora nization/Individiid): Address: ' ' City/State/Zip: Phone#: - Aren employer?Check the appropriate box: a employer with. 4. ❑ I am a a EYPe project(required): oyees(full and/or part-timej.* have hired the subconontrantarctor andsew constructiona sole proprietor orpartner- Misted on the attached sheet 1emodelingand have no employees These subcontractors have ing for me in any capacity. workers' comp.insurance, emolitionorkers'comp.;,,ci,ran 5. ❑ VJe are a corporation anditsdin additronred.] officers have exercised their ectrical repairs or additions homeowner doing all work right of exemption per MGL mbin r airs or additions myself.[No workers'comp. c. 152,§If4),and we have nog ePinsurance required.] t employees. [No workers' of repairscomp.inslara„cerequired-] er t no�eowners o suhmit2=lir—that bfhis ox Yaffida t"Isco t it css4hesew she is g; o•orcers`comr ��oc Vit nidicatin th ,a ^ P--En' -:•`crmation. g e3 =e do�2"�'w ork and Mien hire outside contactor t/iiist ra wiC a new amdavit indicating such. +Contractors that ch�k tt;=box murt attached iii additional sheet showing the name of the sub-contractors and their workers'co _P•Pommy information I'am an employer that is providing workers'compensation ii=zcrance for my employees Below is the policy and job site inform¢izon. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy-of the workers'compensation policy declaration pave(shavdng the policy number.and expiration date). Failure to secure coverage as required under Section 25A ofMGL 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification d do hereby certify under the pains and peiud'ies ofperjur]i thczr the information provided above is true and correct Si0dature- -- Date,:—. Phone#: Official use only. Do not write'in this area, to be completed by city or town official t City or Town: 1 ermitUcense# Issii�Authority(circle one): I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G. Other Contact Person: Phone#: I I Information an. d Instructions Massachusetts General Laws chapt= 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written_" An employeris defined as"an individual,partnefship,'associ.,ation,corporation or other legal entity, or tiny two ormom- of the foregoing engaged in a joint enterprise,and including tie legal representatives of a deceased employer,or the receiver or trustee of an individual,pa-ftaership,association ag other legal entity,employing employees. However the owner of a dwelling house having not more than three apartioL eats and who resides therein,or the occupant of the dwelling house of another who employs persons to do niainte_ance,construction or repair work on such dwelling house- or ouseor on the grounds or buil4ing appurtenant thereto shall riot be:'cause of such.employment be deemed to be.an employer." MGL chapter 152, §25C(6)also states that"every state or Iacal 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 ca3impliance 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 um-til acceptable evidence of compliance with the irmrance requirements of this chapter have been presented to they contracting authority." Applicants Please fill-out the workers'compensation affidavit completely,by, checldng 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. Lin:dted Liability Companies(LLC)or Limited Liability partnerships(LLP)-*.no employees other than the members or partners,.are not required to carry workers,, comp=sation 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 stare to sign and date the affidavit. The affidavit should be mtmmed to the city or Umm that the ;ulicauLn iur the pe nen.e�s He, ra r' T; r 1it'or Ii .s ing q ies�aa,'nat the. ar eni of Industrial Accidents. Should you.have any questions rpgardintg the law or if you are rg�itired to obtain a workarss compensation policy,please call the Department at the numbe=r listed below. Self-insured companies should enter their self-insurance license number on the appropriate Hue. , o City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number whiLh will be-used as a reference number. In addition;an applicant that must submit multiple permit/license applications in any oi von 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 t:own)."-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 liceases. 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 pbTson 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,ielephonc;zn Szx_u tuber_. The COMMOnwealth of Ivlassare usefta DeparLmenf of Fndustri.aI Accidents Office of lnregdaaiions ' 600 Wasbingtan Street Boston,MA 02111 Tel. #617-727-4900 tut 406 or 14—/7'1\L*&SSAFE Fax.�6.17-727-7749 Revised 5-26-05 Fax. Location �r Z No. al 7i Date pt NORTH -1 o TOWN OF NORTH ANDOVER CL a p Certificate of Occupancy $ t • / Building/Frame Permit Fee $ _27/ Foundation Permit Fee $ ;,SSACMUSE� Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ r TOTAL $ =— Building Inspet;tor 1 J�t 31/97 13:58 91 00 DOM Div. Public Works \`�InI�tIT*NO. L APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4,40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE � SUB DIV. LOT NO. LOCATION SoZ LI S d Ley a It �N �r PURPOSE OF BUILDING erno a/e 1 a C3A7'H Cp `f OWNER'S NAME N� 1 u . Q r NO. OF STORIES SIZE ♦i � OWNER'S ADDRESS CJ S d 9N� BASEMENT OR SLAB d�QeN �" ARCHITECT'S NAME 73RA D Poi-jar-5 C©iys 77 SIZE OF FLOOR TIMBERS `IST.2 /��[ /4> 2ND A Y l(> 3RD ` BUILDER'S NAME Iagj9D owj frS 60N3 .T SPAN /3\ DISTANCE TO NEAREST BUILDING IV1,19 DIMENSIONS C SILLS i DISTANCE FROM STREET POSTS i( c 0 f(,M,,v 1 ®G DISTANCE FROM LOT LINES-SIDES A REAR N GIRDERS ' AREA OF LOT N FRONTAGE HEIGHT OF FOUNDATION ] THICKNESS 0\\ IS BUILDING NEW NQ SIZE OF FOOTING X IS BUILDING ADDITION Q MATERIAL OF CHIMNEY IS BUILDING ALTERATION e IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �p IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY NQ G IS BUILDING CONNECTED TO TOWN SEWER yes, IS BUILDING CONNECTED TO NATURAL GAS LIN Q INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST 1( SEE BOTH SIDES ✓T EST. BLDG. COS ago©. COST PER SQ BLDG. . FT. PAGE 1 FILL OUT SECTIONS 1 - 3 EST. -I PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM ` SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY Ail ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED /97/27 -f BUILDING INSPECTOR —4 ' d SIGNATURE OF OWNER O UTHORIZ D AGENT ,Q F E E (`�,II' OWNER TEL.N � _ 383 PERMIT GRANTEDD �_ CONTR.TEL.�t �O 3 3 8 0 19 CONTR.LIC.# ��/ " H.I.C.# laa- / 76 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW'D __ _ .F ive e Ae:/ b/v PIERS PLASTER _ DRY WALL , r UNFIN. ADDI T10,'v Q s e-e_ 3 BASEMENT 11 AREA FULL N. B'M'T' AREA '14 16 FIN. ATTIC AREA T N_O B M-T FIRE PLACES I HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 4,1!1 2 3 DROP SIDING _CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDV,/D ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ -BR-KK ON-FRAME- CONC. OR CINDER BLK. - — -- ' STONE ON MASONRY WIRING STONE ON FRAME SUPERIOROOR I II ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. (2 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 11 HEATING WOOD JOIST IV PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. R COLS. STEAM STEEL BMS. 8 COLS. UOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OI l B'M'T 2ndELCE IC 1st 13rd NO HEATING Restricted To: 00 �.. DEPARTMENT OF PUBLIC SAFETY ` CONSTRUCTION SUPERVISOR LICENSE 00 - None Nueber: Expires: Birthdate: lA - Masonry only CS 048810 08/03/1997 08/03/1963 1G - 1 8 2 Faeily Hoees j Restricted To: 00 BRAOLEY E POWERS JR 76 FORREST ST PLAISTOW, NH 03865 Te �orninanrar(r(�r f;-17«.u�uu/Ia HOME IMPROVEMENT CONTRACTOR Registration 122776 Type - INDIVIDUAL Expiration 10/16/98 BRAD POWERS CONST G9740 8 ADLEY E. POWERS JR ADMINISTRATOR 6 FORREST ST PLAISTOW NH 03865 /4ev-i ax4- WA« &PbIc- 6- jP or -^o 13 E V'!T f F1i `J RoNr FLevG-r-io,v -- - �----� N C V l W f} /UevJ aX� FLoo2 fir' a �ClO ouTsir)G_ __ 6axe r FRAn�F GCoo(Z kNee WR!! uN��r C4N��.1e�e�F ` FL o 0 2 To e s u 1 a Te cQ P7- �arToAti oc �cJc,%�vsT- S/4ab SECTION O -F F16D2 C7U e(f �2es �deNc� U u 52L )'j;/9 bgNE /+)a. f9 N clo v e r MP. s 1,29/�7 [� -rSlot r1 oV ,T;o,AJ wi rl, ,rG1C'A r-, C(O—L 3V S 1J,os ?j O/ XV L6�6-ell 5�1yc 'ss{�W �ano�rvy oN �,Sl �NV7 VS!_7 TS' - Sr/o�Lbna�� "i6/d 3c'',�(��1�1 ��b s�1.si•o.�` �.' N_- --- � 1 i i ��7� 21007 -a�v.+.`0� ,� No� L•c•/���� jGl$ rvor� oNn J-/ \C/ /VO �/iS �� al�nO� 1 - — bn�iL crX f ¢ <40J r M5 '�Sno C,r"3 _ILA— - -- SO I Ilr M or✓•�sa� rJO /rb S S ! 1 � 31 or 7 7� / � aA0D >' alb/nSrll i ' I ✓ u V I �� BUILDING RECORD 112 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. i F i /Pro 001) cTi✓c'' �'XisT'�N� K�TC'h eN LG T_ P' 'C� Q 00 C �' lV � o- a'- a S Tory llv�eil at 50 ia5. o` Re�v� Sse?c ou,�7'y ge jex7-rr b F je�DS /O(p A'j' ¢L L er'�# . p1q fieef=zr4775- cf 1 i (off eqT OpeNIr'a, a . oo 'D tjo 10, � pperrti �,�Tl� ' I �' TNS T c (sgraae. SiQ� Io 11 I leq EY Jo I s I nb�ble a�lo �a'sr ob ol3�eTiv(E FJ� d1 ATfI 0 I rideS"Ee ryer %z TT F T " govc( F_K/>,4 N D ; X/S TSN T� g DOW� _ I �ouN J'- /J K)Tch e n� . All WiT�,N eoipryN; Er-I, OF E�SiSTi� s'ovMe�a7'ioN r � � 3 I f Joon i5 ctusy O FNI�� i V)PLL To VJiNDo\t/ Csf����- � � S p o o-F' 1 i t� E. oyF R 1'o CeriTe� 5-`��a t' t,3 t-\ d v �),1�ead�r •rc 6 e p •r � r� WRLL ppeN�N� To U Qo ehe�k �ra�E �I' R� CJS New 13P�N WiN7vw' h ELevL-A ri0tj-s v d1-3 o ' 6�Diree- "-� builc�e r R�� t�ower'S co�.,sT I pir�cT�oNeF eisT F/a©R o �T f/J �a►sed ?lo le-�arres, T S ©385 N��h Flo-"R PZEF — For, Drq;nJ P/,;s To V,/ NH ° FS !� °•� �urPoses P�°rte (�03 38a- gg9� a p e 4gr (ao3 3 .R.1 Z Z J3 4 Prd erJ GfaNTa�e�e OVF-R FOufJ, CODE !�ro SiSTer carry64/e- I �N o Ngo u YE R ' /IJ C Gs3�iN��s gv f� L 9N� /UO, fiNdovE2 rYlf�ss. __ s DATE 4—j'? 7 rIORTjy Town o t_ _ over No. OYJ a-m-F—W -7 dover, Mass., X? 19?2 LAKE -COCHICNEWJCx TE6 A BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT..........................................4�)4yeoq...........Q. EP a........................................................ BUILDING INSPECTOR Foundation I= PWMIS31on to No*.......4AT.�. . .......... buildings on ..........5.�Z.........*L 0 ji!�� 1-5.04...........!��- .. . 4 ........ ........ Rough to be occupied as.............................................. ......... Chimney pmkimed 'U'W-'t the person accepting this permit shall in every respect conform to the terms of the application on file in Final ft office, and to the provisions at the Codes and By-Laws relating to the Inspection, Alteration and Construction of BuOdIngs 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 CONSTRUCTIONS Rough ............................... .. .. ....... ................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Det. MASSACHUSETTS U? IFOR, APPLICATION FOR PERMIT TO DO PLUtiigING MA (Print or Type) D3 - Mass. ate-4 19 1�'7 Permit x �� ��✓. .4�f)nua� 2-/R _ 2 �v ll02 1�E d, u o Owner's Name U—/111011 Building Location i c i9 Type of Occupancy �4& New O Renovation �$ Replacement C3Plans Submitted: Yes C3 No FIXTURES W Y N q Y O •� - d y.. O - w h- W N N U V = C O O UA Q S _ y O z X O W d 1 N H O h• U -� BASEMENT I ,f I I I I I I tS, FLOOR IxI IX ZNO FLOOR 3 A 0 FLOOR I I I I I I I I I I I 4TH FLOOR I I I I I I 5TH FLOOR I I I I I I II I I I I I I 4 TR FLOOR I I I I I I I 7TH FLOOR gTH FLOOR ( ( I Z 1n� Check one: Certificate Installing Company name .�� ❑ Corporation fT Address / s � ❑ Partnership 9 Firm/Co. Business Telephone Name of Licensed Plumber INSURANCE COVERAGE: ance policy or its substantial equivalent which meets the requirements of MGL Ch. 142• ( have a current liability insur Yes 2 No ❑ 1f you have checked ves• please indicate the type coverage by checking the appropriate box. A(lability insurance Policy ❑ Other type of Indemnity ❑ Bond ❑ (kation waives this requirement. OWNER'S INSURANCE WAIYER:IIaaYm and that signaturevonothis permt appes not have lication insurance coverage required y Chapter 142 of the Mass. Genera Check one: Owner ❑ Agent❑ Signature of at or Owner's Agent true and ac=rate,to the best of mY on are I hereby certify that all ofl the d t�work andiu�s a(lations oertormedtunded(er the permit issued foof entered)in above r this application will ben comp)ance w ith ail knowledge and that all p 9 pertinent provisions of the Massachusetts State Plumbing Code and hap�1144,24f the Genera ws. ,gnature o Ucansed Title Type of license:Master 6 Journeyman❑ Cr f wn t r U NLY License Number . r • Date.??'_./. .�`�.�J G 3213 F HORTM .'� TOWN OF NORTH ANDOVER 4 3? ,.t '•ooc ' 0 F PERMIT FOR PLUMBING ,SSACMUSE� This certifies tha,�7�.�-,,n . . . . . . . . has permission to perform . . .!. .. . . . . . . . . . . . . . . . . . . plumbing in the uildings of -r!/Z,...-•.•-- at. . c� . . . : .�,2s�!{ ... . . . . . . . . . . .. North A dover, Mass. Fee-3 . .Lie. No..//.;).`�./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR {{ N;o 02/20/97 16:11 30.00 PAID 1 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer PER:IIIT NO.C2t C APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE i 1 MAP NO. I LOT NO. 12 RECORD OF OWNERSHIP DA'T'E BOOK PAGE - ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES OWNER'S ADDRESS BASEMENT OR SLAB !� ARCHITECT'S NAME r SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME / _ l/ _ SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE V HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 71 /,! ". a(4 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 PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY r ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST B [LED AND APPROVED BY BUILDING INSPECTOR DATE FIL BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED A dq FEE e- PLANNING BOARD PERMIT GR TED 19 BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ \ 3. 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'T' AREA _ y, 1h '/ FIN. ATTIC AREA _ NO B'M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D _ ASBESTOS SIDING COMMCN - t, VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. SIONE 014 MASONRY - WIRING STONE ON FRAME _ SUPERIOR I-I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 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 II 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 GASOI L B'M'T 2nd _ ELECTRIC _ 1st 3r1-11NO HEATING Office Use Only �il 19 014t (lbm llnuIPg� of 11if3IIL 1Mttt6 Permit No. `-3 r, V Bleprtma i of JlWic Onfetq Occupancy A Fee Checked-41S BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) 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 ._ ?:- /n QG} or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) �—sA �� it�� 4)� Owner or Tenant -� ��� r�:✓CJ �� ����� Owner's Address �•� Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building l u Utility Authorization No. Existing Service DU Amps 442LJ. Il Volts Overhead l Undgrnd ❑ No. of Meters �. New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets I No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures ISwimming Pool AboveIn- rI Generators KVA grnd. r— gnd. No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets , No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and 9 I tons Initiating Devices No. of Disposals No.of Heat Total Total P i Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices Municipal No. of Dryers Heating Devices KW Local `I Connection F-1 Other No. of No. of Low Voltage No. of Water Heaters KW ( Signs Ballasts Wiring No. Hydro Massage Tubs ! No. of Motors Total HP / 7 G INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws _ I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES = NO _ I have submitted valid proof of same to the Office. YES = NO = It you have checked YES. please indicate the type of coverage by checking thea ropriate box. r c, INSURANCEBOND = OTHER = (Please Specify) (Expiration Oatei Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAME 3c& UC. NO.� Licensee _� Signature_ LIC. NO. _ 14� Bus. Tel. No j Addre � ���6� OWNER'S INSURANCE WAIVER: I am aw re that the Licensee doe not have the insurance coverage or its substantial equivalent as re quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner /A1gI/e\)nt (Please check one) / Telephone No. PERMIT FEE 3 (Signature of Owner or Agent) x-6565 Date..... . .. ........... ......1. •.r^ 2693 v � raOR7M 1 ° t"`° '• "� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING C� ,SSACMUS� f { This certifies that ........ ..0......... .`............../ .../......r1...`............................ ' has permission to perform /`...... l� �..... m'P.... x .......... ....e r /UJ..e................ wiring in the building of.:.......1/d/..�f:f....✓... .. ........................................ fi L ' .. ...`�V North Andover Mass. at....................................... ......................... , . ............. Lic.No....... / �)....b...7............................................................... ELECTRICAL INSPECTOR I CJ 11/09/95 13:26 5.00. PAID 11/09/9513:26 10.00 PAID WHITE: Applicant CANARY: Building ept. PINK:Treasurer GOLD: File a � Date...4..-�..l....... 113 788 f NORTH 1 TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ,SSACMUS� This certifies that ........... .k✓. .... tC......... .................... r has permission to perform .......... . .. �.. . J :. ....................................... wiring in the building of.... s......... - ............ at..... ...6.`�?, ... .ht.,.. ... . .. .......... ,North Andover,Mass. FeA ..... Lic.No.4.1.0-13t4.......... .......... ........................... ELECTRICAL INSPECTOR C { 7 02I20/97 16:08 65.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer (Omce Use Only - line �utnmurt>ru>' lfh of 5gz1rhu5z� Permit No. ;3zP l=rIi2 Df �lIhiiz —wafEti Occupane/& Fee Checked (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CtdR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CM 12: 90 2 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (X)� or Town of NORTH "unnvFR To the Inspector of wires: The udersigned applies for a permit to perform the electrical work described below./ Location (Street 3 Number) S2 G I Sl/4 /'?-e Owner or Tenantry? Owner's Address _ Is this permit in conjunction with a building permit: Yes No 1- (Check Appropriate Sax) Purccse of Suildino -5in' 1 /� Utility Authorization No. aF7Existing Service /Ut Arms IG G 247 VCits Overhead ' Unagrnd No. of Meters f New Ser�ice Amos _/ Volts GverheaC _ Uncgrnd — No. of Nleters Numcer of Feeders and Amcacity Lccacicn anc Nature of Proposed Electr.caf .'IcrxeT Ob �` F Tocai /�/ No. C• T bs 14c. of Transformers KVA No. at L:gnung Outlets `�' I Aocver— in- No. at ,:gnung Fixtures i Swimming Pont grne. _ cmc. Generators KVA iNo. of Emergency Lighting No. of Pecectacie Outlets /6 No. of Oil Burners j Battery Units No. of Sw tcn Outlets No. or Gas Burners I FIFE.ALARMS No. of Zones Total No. of Cetection and I No. of Ranges I No. of Air Cr.ne. fans Initialing Devices Heat otai alai I No. at Cisoosals I No.af Pu—as Tons ',<,4No. at Sounding Devices No. a Seit,;on Contained SoaceiArea H.eauna KYJ OetecaoniSounoing Devices No. of Oisnwasners .- I Heattna Devices KvV ` Lccai Municieai —otherNo. at Drvers , _ Connecaen No. at No. of I Low voltage No. of water Heaters KW Signs Ballasts Wirtnc No. Hvero Massage Tubs I No.,+of motors Tetai `P J d INSURANCE CCVERAGE: Pursuant m the requirements at massacncsa-s general Laws t_�/NO _ I have a current Liaoiitty Insurance Policy inctucing Camo:etec Ooeraucns Coverage or Its suostanual eeulvatent. YES have suominea valid proof of same to the Office. YES t:/ NO _ If ';cu nave cnecxec YES. ~tease inatcate the cvee of coverage Cy cnecK ng !ne app arcate cox. INSURANCE _ BOND = OTHER.�g} : �(Please Scec:'y) 7 1 (Exairauon Cale) 6rzzle•� 7 ,7A 7 i JFnai Esnmacec Value of G.ectr cal `Nark S l worK :o Start . 7 Insoec:ion Date Racuestec: Raugn Signea uncer the Penalties of perjury: / LIC NO FiRM NAME, ///y f-0 cle'a-^/C UC. NO. Licensee �t rya �1 r' Signature 9 ) ` f� Bus. Tat. No. Address 3 0-7—s/� Au. Tef. No. OWNER'S INSURANCE W ER: I am aware that the L:censea apes not nave ;ne insurance coverage or uirits suostanual eeutvalenA ent auirea cv Massachusetts General Laws. and tnat my signature an :n:s oermit aopucacion waives anis reowrament. owner �9 (P!easa cnecx one) _ l� 5 a —etecnene No. PERMIT FEE 5 iSigr,ature at Owner or Agena