Loading...
HomeMy WebLinkAboutMiscellaneous - 52 RIDGE WAY 4/30/2018 52 RIDGE WAY -- 210/09=3,0000.0 Libe� Mutualm Liberty Mutual Insurance New England Region Central Property Unit INSURANCE 75 Sylvan Street Danvers,MA 01923 Tel:(800)566-0323 May 12,2015 Town of North Andover Attn:Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address:52 Ridge Way,North Andover,Ma 01845 Policy Number:H3221834446840 Underwriting Company: Liberty Mutual Fire Insurance Company Claim Number: 031884470-0001 Date of Loss:2/9/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, 5 6 applicable. You are required to notif T Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, 599, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, § 3A & B, or Mass. General Laws, Ch. 143, � 9, or Mass. General Laws,Ch. 111,5 127B. This letter should not be construed as a waiver or estoppel of any of the terms,conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 • Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING C14US This certifies that ..................................................fli... ............................. has permission to perform ............ .............................. wiring in the building of...... .....MA 6.1< ....................... ..........................Pfqth Andover,Mass Lic.No. ................. . iMPE ELEI;04 CAL�INSPE / Check # 10506 f \ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank) 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: v Z W 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) 2 p Owner or Tenant Telephone No. Owner's Address S Rn e. Is this permit in conjunction with al building permit? Yes [0"" No ❑ (Check Appropriate Box) Purpose of Building 9t)r✓JOdP�� JCfkng,7 Utility Authorization No. Existing Service Z0 o Amps 120 (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: &a Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires 20 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets r(j No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 11 o.o Emergency ig mg rnd. gr d. Battery Units No.of Receptacle Outlets 15 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and I Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump 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 ecurity ystems:* = No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs 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 Work: ®Q0, d (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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE R"' BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 'I i�� LIC.NO.: Licensee: >�i9�►7 &e r's,i1 Signature Of LIC.NO.: ^J y/3E (If applicable,enter " empt"in the{icen a number line Bus.Tel.No.-.(50 SL3 6 3 Sq Address: 7 Q�r�IGrv,100c, 1.40e &4 C N#10ZD(a-L Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. y signature below,I hereby waive this requirement. 1 am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Dom/ I ,Y 75yz The Commonwealth ofMassachusetts fment o Department Industrial Accidents P Office of Investigations 600 Washington Street Boston,MA 0211.E qF www.mass.gov1dia Workers' Compensation Insurance Affidavit: ]3uilders/Contractors/FIectricians/JPlumbers Applicant Information Please Print Le0bly Name(Business/Organization/Individual): ), V iN Address: t2��f,� w+4, City/State/Zip: /1fiJl l t4 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.❑ I am a sole pro-Srietor or partner- listed on the attached sheet.I 7• Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. n Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its equired.] officers have exercised their 10.E]Electrical repairs or additions 3. 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.] employees.[No workers' q ] 131-1 other comp.insurance required.] *Any applicant that checks box 41 nmst also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: i 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 STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certify under the pains andpenalties ofperjury that the information provided ahove is true and correct. Si afore: I --� Date: Phone# Official use only. Do not write in this area,to he completed by city or town official. City or Town: PermitUcense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectricaI Inspector 5.Plumbing Inspector 6.Other Contact-Person: Phone 4: DateL ....�. ....�.t ..... K' NORtM TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACMU This certifies that � has permission to perfor ..........ml9... ............ wiring in the building of Dwila..... r'l.L /��i u"'�' ... .... :. .... ................................. ;5"Z x,40�.+w,4dJ at... ............. ... '.......................... . North Andover M 7. 'gee..... �r.. Lic.No.� ?� / ....... ..... + ELECTRICAL INSPECTOR Check # `107` 8 Commonwealth of Massachusetts Official Use Only a Department of Fire Services PemiitNo. 1 f1 I'� BOARD OF FIRE PREVENTION REGULATIONS [ ] Occup nyandFeeChecked (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 INXNKORTYPEALLIIVFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice f his or her intenti�torform the electrical work described below. Location(Street&Number) ; Owner or Tenant of v ,� ;L Telephone No. Owner's Address _ 9�n fL Is this permit in conjunction with a building p mit? Yes No ❑ (Check Appropriate Box) Purpose of Building-040" 1 � Sy Utility Authorization No. Y Existing Service Amps 12o/ Zyj`polts Overhead❑ Und rd g � No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion of the ollowin table mg be waived b the Ins ector o Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators r KVA 15000 No.of Luminaires Swimming Pool Above11In- ❑ o.o mergency ig ing rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FME ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and • Initiatin Devices - No.of Ranges No.of Air Cond. TotaTons No,of Alerting Devices No.of Waste Disposers Heat Pump Totals: Number Tons ' KW No.ofSelf-Contained ........._....w._......__._....._._........ Detection/Alertingy Devices No.of Dishwashers Space/Area Heating KW Local❑Municipal ❑ Other Connection No.of Dryers Heating Appliances KWSecurity Systems:*. No.of Water signs Ballasts No.of Devices or Equivalent Heaters KW No. as ts Data Wiring: Si ns BalNo.of Devices orEquivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No,of Devices or Equivalent FoTHER- Estimated Attach additional detail if desired,,or as required by the Inspector of Wires. Value of Electrical Work: QQ 47(1> Attach 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 cove age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 9 BOND ❑ OTHER ❑ (Specify:) Icertify,under thepains andpena_ *es ofpedury,that the information on this application is true and cor pleie. FIRM NAME: , LIC.NO.: Licensee: go, Signature LIC.NO.: 9 /3 (If applicable,?n—ter`exemzt"in the license umb r line) _/ Sus.Tel.No. O Z S'g Address: _ `S�.)o/Y��Db /��/'A10,94 /�j� ©?��-7"'t.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department ofPublic Safety"S"License: Lie.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 ❑owners a' ent. Owner/Agent Signature Telephone No. PERMIT FEE.S r raced--[ e-zuspeetzott xequueLY($50.00) �nspectQrs'co7mxae�ats: - Qkn peefore Signature-:ao Ulals) Date 2.MAL INSP)gCtION, Rassed•--[ ) varled--[ ) E�exnspecfiox�xer�uixee�($50.40)[ b x"Vectors'comments: 1_ (�is�iectoral Ngnature•-no rnrtrals) Date, 3,umn,C:E oum IN"Oe- TXON.. , Passed— Inspectors, assed Inspectors'comments: (lnsp ectors'signature no `Era ]ate 4 W,9PECTXON— VICE': Passed--[ ) Nailed•-[ e-fnspection x squired($50.OD) j ] Inspectors'eoammepfs: • (bspectors',gzgaature-zoo xnr-Lqals) Date r INSPECTION--OMR- I' as.Pectors'colilments: edors'81gnature-no znrdals) Pate 1)0Off.TAGS AM TO EE F+JtiE T 0 11 T A WD XMFT ON SITE N TH E.APXA TO 3E INSTECM I'S NOT A"CCE98MLE AND_A'RVMY'q-P-V,,(-V,( Da s'o-04 r.q Tn xz1�.(W- APrFn . Date . . .�. . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that N . . . " . . . . a . . . . . . . . . . . . . . . . . . . . has permission for gas installation . .'... . ... . . . 7`lp O�-. . .+. in the buildings of.y Z.. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . �"� `� . , orth Andover, Mass. Fee%�v . . . . Lic. No`?�'�,. . . . . . . . . . . GASINSPECTOR Check# 22 15 8371 a IMASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK x CITY /]/�y , j 1/ lam`_ MA DATE / // _ PERMIT# JOBSITE ADDRESS OWNER'S NAME GOWNER ADDRESS TE 'LQ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:E3 RENOVATION: REPLACEMENT:El PLANS SUBMITTED: YES-I NO __ APPLIANCES'l FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER1I- COOK STOVE DIRECT VENT HEATER DRYER1 _ FIREPLACE FRYOLATOR FURNACE --- - - --T-1 - ( — -- — I-- 17D -- --1 - - GENERATOR E—j _-_.-1I_- 1 -- . - 1 - ._. . GRILLE INFRARED HEATER LABORATORY COCKS [_ I.�T 11—�p1._---T-s� �..z ( _ -1 _—�� _�-- MAKEUP AIR UNIT OVEN _ [-7.1 POOL HEATER ROOM/SPACE HEATER --.-- -- ROOF TOP UNIT TEST _I�- —J L_:_,V J ( J�_ _(L��I ,__J. ( --�,�_ l(- f• UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _I OTHER A INSURANCE COVERAGE - _ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES "NNO �( IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY Ej BOND Ej 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 0--' AGENT SIGNATURE OF OWNER OR AGENT 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 permit issued for this application will be in complianAwithertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME LICENSE# oZ� .. SIGNATURE MP 5 MGF _ ( JP [ JGF Q LPGI 0 CORPORATION REF�3 PARTNERSHIP 0#=LLC[J# COMPANYNAME: }��/ ;S )ADDRESS e� r CITYANGSTATE ZIP ��`/. TEL FAX -- CELL -- --...._.._�EMAIL 6 –.f 0-:20S ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No ® '1016111-z-- THIS 3/ 2..THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Pq The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ,Y www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): , aqnm) Address: , City/State/Zip: Phone#: AYUan employer?Check th appropriate box: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part- tme).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. Y p tY• 9. E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 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#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 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 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 Df 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. f do hereby certl under the and penalties of perjury that the information provided above is tr a and co ect. 54ature: Date: J 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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"...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 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-contractor(s)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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(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 burn 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 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www,mass.gov/dia COMMONWEALTH OF MASSACHUSETTS ` { COMMONWEALTH OF MASSACHUSETTS • . AS A MASTER-UNRESTRICTED pL'U,MBERS AND G;`.;�FITTERS ISSUES THE ABOVE LICENSE TO: i LICENSED AS A MAST ER PLUMBER ISSUES THE ABOVE LICENSE TO: DAVID A. DIBONA d DAVID A DIBONA =FIRST GLASS PLUMBING i d� 20 JEWETT ST 20 JEWETT ST QUINCY. MA 02169-2802 plc 462 06/28/13 10572 QUINCY MA 02169=2802 LICENgE ,1,2946 05/01/14 1-69.607 • • • . -COMMONWEALTH OF MASSACHUSETTS - .*COIVIMONWEALTH.OF MASSACHUSETTS PL M13ERS AND GASFITTERS 'p.Lam'. A!�ID GASFITTERS \�� LICENSED AS A JOURNEYMAN PLUMBEIw REGISTERED AS A PLUMBING CORP I ISSUES THE ABOVE LICENSE TO: ` ' ISSUES THE ABOVE LICENSE TO: DAVID. A DIBONA DAVID A DlBONA �1a I� 20 JEWETT ST �m . FIRST CLAS PLUMBING & HEATING 20 JEWETT ST VIS UINCY MA 021G9-28Q2 QUINCY MA 02169-2802 24159 05/01/14 1.69608 2832 05/01 '14 169.60.6 l COMMONWEALTH OF MASSACHUSETTS a • •' ' S " AS='A BUSINESS ISSUES THE ABOVE LICENSE TO: DAVID A. DIBONA FIRST CLASS PLUMBING AND HEATI 2-0 JEWETT ST QUINCY: MA 02169-0000 100 11/04/12 969250 / • '' mcm f' f 1 ! t i N- 96 ,i 8 � ° Date. .d . . . . I s t MORTq ' •'�a TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i 'SSAcmU`+� This certifies that !�'. . . . . . . . . . . . . . . / A has permission to perform !r�-?`.� - p!?`.'/Z. . . . . . . . . . . . . r � plumbing in th buildings of . ./t-/Aa:/­-,0, 5'e-- . . . . . . . . . . . . . . . at. . �. . . . . . . . . . . . i . .�— tN. .Q' ., North An ver, Mass. j '\Fee, Lic. No/-�. . . 1�10 . . . . . PLUMBING INSPECTO Check # ' WHITE:Applicant CANARY: Building Dept. PINK:Treasurer i . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK U1W CITY -er € MA DATE ZMIT# JOBSITE ADDRESS / I OWNER'S NAME QI 4L POWNER ADDRESS _I TEL f� X TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: El RENOVATION:0-'REPLACEMENT:Ell PLANS SUBMITTED: YES NO FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 S 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ( _._.-. _. i _._ .T._..__! ..__..._.I _€ -.-_ __€ __-_i ..,-__..! - _ DEDICATED GREASE SYSTEM __......_i DEDICATED GRAY WATER SYSTEM �._I DEDICATED WATER RECYCLE SYSTEM _—_..1 DISHWASHER DRINKING FOUNTAIN ( ..._.......! ----- -------- FOOD ___---__I I ( ._.__..._I f _-! ._._...._! ! _._. ( ---.._...€ FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) i i ...---._._i KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL € ...__J ..__..._._i __...-..._I J ....._...._.._I ._............i .---.-......� __..._...._.i € ..._.._._.1 ! .__.._._._€ ..__.__.! ._...._.; WASHING MACHINE CONNECTION _i _ _._i _.. ! _€ . .. ._! I i I WATER HEATER ALL TYPES _ i f f _._- i _ WATER PIPING _ i �€ 1 . ..._...E I _€ -) - -.- ( --..._..._! I _.... . .i __.. .. i OTHER i _i ..._...__.f _.__._.J I i __.........f _._._....I i € ._.....__! _� _ _! I �j € I IL I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E! 1O E IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 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. CHECK ONE ONLY: OWNER 01 AGENT SIGNATURE OF OWNER OR AGENT 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 permit issued for this application will be in compliance h II Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .,. PLUMBER'S NAME LICENSE# SIGNATURE -- MP© JP 0 CORPORATION Fj# i PARTNERSHIP 0# _- ?LLC �J nn �I� COMPANY NAME ; ADDRESS ,Z(� CITY __I STATE ®ZIP [�� !2 TEL FAX CELL i EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No Z THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES O The Commonwealth of Massachusetts rn Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 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.F1 am a sole proprietor or partner- listed on the attached sheet.$ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]f employees. [No workers' comp.insurance required.] 1311 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 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 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 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 official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �s 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"...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 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(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 burn 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. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF MASSACHUSETTS AS A MASTER-UNRESTRICTED PL'U.MBERS AND GP.;�FITTERS ISSUES THE ABOVE LICENSE TO: i LICENSED AS A MAS1 ER PLUMBER i ISSUES THE ABOVE LICENSE TO: DAVID A DIBONA DAVID A DIBONA FIRST CLASS PLUMBINGN 20 JEWETT ST 20 JEWETT ST +` QUINCY MA 02169-2802 t 462 06/28/13 10572 QUINCY MA 02169-2802 EXPIRATIONLICENSE NO. D. . 12946 05/01/14 159607 • OKI I `COMMONWEALTH OF MASSACHUSETTS :COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A JOURNEYMAN PLUMBED PLUM,ii�:RS AND GASFITTERS 1 ISSUES THE ABOVE LICENSE TO: REGISTERED AS A PLUMBING CORP t ISSUES THE ABOVE LICENSE TO: DAVID A DIBONA DAVID A DIBOW 20 JEWETT ST � FIRST CLAS PLUMBING & HEATING 20 JEWETT ST QUINCY MA 02169-2802 QUINCY PIA 02169-2802 - 24159 05/01/14 169608 t �} • • LICENSE 2832 05/01/14 169606 LICENSE • . EXPIRATION DATE S�RIAL NO. COMMONWEALTH OF MASSACHUSETTS :.• . . b"ttT METAL WORKERS 'AS-A BUSINESS ISSUES THE ABOVE LICENSE TO: DAVID A DIBONA FIRST CLASS PLUMBING AND HEATI m 20 JEWETT ST QUINCY MA 02169-0000 100 11/04/12 969250 l r i' J r r Date. � /4�....... . c HORTM Of�..ao o? TOWN OF NORTH ANDOVER - PERMIT FOR GAS INSTALLATION a i e 9 �9TSACHUSEtt This certifies that . . Gam' �rer, has permission for gas installation . . .r . . . . . . . . . . . C' 2/e in the buildings f . . . . .�. r�/l. . . . . . . . . . . . . . . . . . . . . . .. at . . . .--�. . . .. . .+ �.t. . . . . . . . . . ., No h Andover/Mass. Fee. . 25i Lic. No.. rz`3 t!-�`� . . . . . . . . . GASINSPECTOR Check# JD z 8137 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:1 North Andover Date: 04/25/2012 1 Permit#^� Building LocatiI Owners Name:I Mackenzie Type of Occupancy: Commercial,-] Educational Industrial Institutional Residential New: Alteration: Renovation Replacement:© Plans Submitted: Yes No� FIXTURES W W (a N Z ~� N V = m = O W W V W IN- O = re W O Z Z O p� FW- W � O Q F'- N W U) W m O a W K W Z H W = _ O O u. Lu W Z = W ~ Z W U) J ~ ~ m W O z O ~ W ~ W W 00 > z c QlA. 9 0 X i 5 O' °a 9 L�U- > > > 3 0 SUB BSMT. BASEMENT 15T FLOOR { 2ND FLOOR -'3'FLOOR 4 FLOOR 5 FLOOR 6 FLOOR -'7'FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: Michael Waldman Plumbing&Heating, Inc. Corporation 1370C Address: 12 Essex Street City/Town: Lynn State: MA Partnership Business Tel: 781-593-7490 -0410 Fax: 781-599 ❑FirmlCompany Name of Licensed Plumber/Gas Fitter: Michael Waldman INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YesE01INQ If you have checked Yes.please Indicate the type of coverage by checking the appropriate box below. A liability insurance policy© Other type of indemnity L1 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 Signature of Owner or Owners Agent Owner D Agent By checking this box❑;1 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 permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Byl ---� Type of License: Plumber Titlel j F-j Gas Fitter Signature of License lumber/Gas Fitter Master Cityrrownl Journeyman License Number: 17234 APPROVED OFFICE USE ONLY LP installer I _ - LOT 48 22,538 S.F. ExrsrlNc LOT X49 HOUSE 24,062 S.F. LOT r' 23.59a LOT 47 1 21,7 80 S.F. ., EXISTING HOUSE f%i5Ii,�:G FOR ��OISTRY 0F DEEDS -USE ONLY EXISTING HOUSE N N16*32'43"W LOT 46 y� , i 21, 780 S.F. 0 1+o2 - o -- --EXISTING HOUSE HOUSE W T REACE ti j�' 345.82 S16'32'a;5;=,- --- , ld� 49 309.27' .45 1 45.55 BD-PT x IN ELEC. p 345.5.3 e� T ANS. BASE \,l ``• 9 EXISTING C` p I -HOUSE �x�s iI q J HOU EXITING VI HODS OUSE T N I N EXISTING o HOUSE LOT 5 LOT 57 LOT 561 28,229 S.F. 34, 782 SA 22,677 S.F. 28 y i'k .�`�r t� • 'ate_ B� Q�� ni Date......1........................... . O� Ho oTh , --6 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING Ar D C" SSACNUS� ;r. L. This certifies that ....... 7S,n�� > ............................. ...... .............................. has permission to perform ........ / �!-�✓ ��IVTz wiring in the building of.......... it'.). ................................................... at..... . .f ?.....s.... . . .......S./........................... orth Andover,Mass. ° Fee .5............... Lic.No. 8/.9 �'�... eCI&CAL � rOR l Check # � o6a'8 t.onmutnroeaf�s llla � offdal Use owy BOARD OF FIRE PREVENTION REGULATIONS6r `ll Wd Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AZwa&wbepmrfmmedin R tbeM lC)&Oac, w cam 17-an (PLEASEPMVT2NrNWOR £ =-FO i 02 1/ Cky or Tawe a� /G�(J / To the o09 c: BY this apgiication ti p+ =.rte ofh"s a� r n tt's��g t�e�ectricat wo&d below L•oamon Ouva&Nambw) Owner orTe o(-�,QTavbmeNs. laktl Ownees Address C2-4w--Ql is this permit m cos}andis v t s pum Yes ❑ No f (ake&Alrpropflaft Boz) Ptirpase of Nffdmg Uffay Awa No. Exisfmg Servide Amps i Voft - Ove Undpd❑ No.ofMeters New Servim Amps / Vaft Ovwhead❑ Undgrd❑ Ne.ofMeters Number of Feeders aad Ampafty Location and Nature of Proposed Elecakd Work K rhe urlile hewed theofTPs_ No.of Recessed Lmamaires ,ofC (tom)Fay o` No.of Luminaire{u,ds No.ofHa Tubs Generamn !v KVA No,of I�tmi " Ped Above ❑ ht" ❑ lg�aUaft No.of ReceptaeleOutlets Nt&9f09Bmmers FUM Ai AMM i�, No.of Switches No.ofGas Barmen o' IniflaftgDevion No.ofRab8a No.ofAirCond. To= a ofAlmtmg Devices No.of Waste Des Total Toni ' Davk . No.of Dishwashers SpacdAreaHem KW Leed❑Cam ❑tither No.of Dryers EkaffmgApp§auces RW of or NO.ofH�este3s KW IL of Wim sizes Na.ofd or No.flydromnswpBoftubs w ofMotors Total HPmswuuw No,ofDevices or ` OTHER: r A derm7ifdsbw4 oreump odbythe hqwcmrofWmm Estimded Vahv--of ElecWcal Work (Whm meed by mmwVd Polcy) work to Stare Into bei is accardmm withMRC Rale 10,and upon compledm INSURAWM C4`►l3SAC-.E: Unless waived by tate owner,tto permit forthe pelf mmmm of clecMcal yuck nmay issue uniess the ftcensee provides paofof 9 iadacfmg"com plMd opmadomr coves or its subsumfid equiv&=L The tnidetIned cxrmcsthatsack0:01M s mforce,atdhas cdobhed pwofofsatneto the permit iss - goTur- _ ONF: WSURANC£ ❑ OnM ❑ efp (SPAY=) I crr¢ rrAeferthe and ta ip,tbat8ie" d& is true mid awrierm FIRMNAME: 2f1�} r. 5 1 LIG NQ:A-Z/&i� _ Licensee::7y�r,�i�,r�%S I�PIO»�'f'��l1rJ� Aft emir-cwmpr"6,the Ucmw mmrhw UwJ ll�.Tei.No4 291y 3 /r AfteL *Per M-G.L.c.147,s.57-51,smwity.wwk recptires ofPa &3atety-r Lit Lit~No. OWNEWS Ilg5I3RAl4CE WAtVEIL I mn=mmt ttb does nw I�the y oover-age normally m* b9 law By my bebw.Ihm * I am the(check ate)❑owner 0 owner's age-at. ��—�11.. Fva S Y it Date.. . J .. . ... . .. ...... MOFTM TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SACHUS s TTiis certifies that . . :. . . . :. . . : . . . . :l. . . : . . . . :: . . . . . . . . . has permission for gas installation . .-:.. . .` . . . . . . . . . . in the buildings of ... . . .. . . .h... . .: . .. . ..... . . . . . . . . . . . . . . . . . at '` . . ��� ,��. . . . . . . . ..... . . ., North Andover, Mass. Fee . . . . . . Lic .. .... . . . . . . . . . . . GAS,INSPECTOR Check#" `f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print /or Type) .UV /l �y /T/VI�� • Mass. Date 2r- O�_ Permit # Building Location _ Owner's NameD i / PA kJ Type of Occupancy_ New ❑ Renovation ❑ Replacement ©,-� Plans Submitted: Yes❑ No ❑ N C H W N N N U H En cr yr n: o J W W o W < c: O l m F' v ur 0 H ul b w < x 7: p- in O > w N C W X_ W N 4J < C f- c N x r 7 X J ._ +. X a W G W W U H a _j !� X W L!. p > LL !-� W J W d W > Q tp < cc <s r z u. M o d u ¢ > c a F- o SUB—BSMT. BASEMENT 1STFLOOR 211D FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR eTHFLOOR installing Company Name_ 1+11AI, /�C, tl Check one: Certificate # Address ` t Q Q`Corporatlon yA' ❑ Partnership Business Telephone_c (o ��j 3 ❑ Fir /Co. Name of Licensed Plumber or Gas Fitter T/� C/�L/�/,/ �A INSURANCE COVERAGE: I have± a current IjAWfty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. � Yes Ua, No ❑ If yod have checked yes. please Indicate the type coverage by checking the appropriate box. A liability Insurance policy �� Other type of Indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: S+gnalure of Owner or Owner's Agent Owner❑ Agent ❑ 1 hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installationserformed under p n er t Ire armlt Issued for this application pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of the Gengjai Laws. pp n Will be In compliance with all Type of License: Title Plumber Srg /l�u(e o� c,nyse u�-mbeI rA�o> r�G�a?s t eer osfillor City/Town Osler Ucense Number ,lX-mr-j FI`TrO JourneymanNT 4667 t Date..................`.'5....�....Z NORTI{ °ft •."° eTOWN OF NORTH ANDOVER ......• of p PERMIT FOR WIRING ACMUS� This certifies that �-'�-�� - -- ................... .... .................................................. r has permission to perform ..... r I..... y..........,-�J-�� ............ wiring in the building of..... ............................... at... .m......... .............. . .� .. ... ...................,North Andover,Mass. L � v� l .......... .................Fee�, U............ 1Z le � Check # Commonwealth of Massachusetts O ficia se Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 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: `t—'D- UJ— +1n � � +' To the Inspector of Wires: City or Town of: /\I o By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 5 Z . C! i,.)Cl 1^�.g✓Gog�,� Telephone No.97a-,�B�.-G?Zg Owner or Tenant Z-au 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: :, L iZ l�^� cjo �r /3"4 i a<a-s- . Com letion 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 Above n- o.o Emergency Lighting No. of Lighting Fixtures 3 Swimming Pool rnd. ❑ rnd. ❑ Battery Units ' No.of Receptacle Outlets Z� No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No. of Waste Disposers Heat Pum Nuber Tons K No. o elf-Contained P Totals: Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW Local ❑ Municipal ❑ Other P g Connection No. of Dryers Heating Appliances KW Security Systems: y No.of Devices or Equivalent No. of Water KW o.o o.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No. Hydromassage No.of Devices or Equivalent it 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 cover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) Cane !D( t o3 (Expiration Date) Estimated Value of Electrical Work: Lill o (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: °� l a�. I r �'�_ LIC. NO.: Licensee: �tt (y�( <<�. Signatu,1611LIC. NO.: (If applicable, nter "exempt"in th h ense number line.)/ Bus.Tel.No.: Address: Y6 l L�o.�'c r�S�. Nla SS 0-9- SL:zU Alt.Tel. No.: OWNERS INSURANCE WAIVER: I am avlare 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 PERMIT FEE: $ Signature Telephone No. Date. .����� 1. %O RT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �,SSACMUS� This certifies that .K. .'. . "C"nN �Cq has permission to perform . etiti ocQ a plumbing in the buildings of . l DU S V-ro&)C o o e.Q> at 5'2 '� . . Q Lo n . . . . . . . . . . ., No h Andov r, Mass. Fee. . 4'�- .Lic. r SB PLUMBIN INSPECTOR Check # `.I{ 5369 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type'or print) ,;4ORTH ANDOVER,MASSACHUSETTS Q /, Dale Building Location' Z �/k �/�7 Owners Name&W15 1X-A) W99r...Permit# Amount Type of Occupancy New Renovation Replacement E] Plans Submitted Yes 0 No FIXTURES d cc v� F W � a O O W U a BASEUM M FILM 211n>F j" / 3MMOOR 4MHIM s>HMOOR MHJOOR RM IEM (Print or type) Check one: Certificate Installing Company Name Ike,�• / �f�i ❑ Corp. Address �g /�� v/ Partner. e, Z/itd Mus ness Telephone ,r ,L Finn/Co. Name of Licensed Plumber: X!0- /i(// Insurance Coverage: Indica e thtype of insurance coverage b checking the appropriate 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 of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed u r Pe ' Is d for this application will be in compliance with all pertinent provisions of the Massachus a lumbin e r 42 of the General Laws. By: Tigna ure 21,171censeariumuFF. T pe of Plumbing License Title 10i City/Town icense Numner Master Journeyman ❑ APPROVED(OFFICE USE ONLY COMMONWEALTH OF-MASSACHUSETTS «_,g IN PLUMBERS AND GASFITTERS i \ LICENSED IOSs�iEsAl-HNSiE� oPLUMBER I f KEVIN L BUCKLEY 83 BIRCH STREETmk ROSLINDALE t MA 02131-3011 . � 13162. I 05/01/04 . 564327 1. � r COMMONWEALTH OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS 'LICENSED AS A JOURNEYMAN PLUMB {� ISSUES THIS LICENSE TO KEVIN L BUCKLEY ;m 83 BIRCH STREET �cj ROSLINDALE MA 02131-3011 E d d 25499 05/01/04 d 4 564328 _. i Location e( c No. Im/ sate ?, NORTq TOWN OF NORTH ANDOVER Oi•«•a .•,�O F?.` • 0A .1 9 ♦ i s + ; , Certificate of Occupancy $ �ssACMUSE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ la o ,-- Check # 15833 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: p%� X C l ic SIGNATURE: Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Z 1 �E Ott Map Num6er Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS fit Front Yard Side Yard Rear Yard Required Provide Reqttired Provided R 'red Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone- ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 caner of Record /,OUT-5 c©lcuz SZ 720645 lit./� N e(Pri Address for Service: 69ol - Z Sign re Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 7i� 3. icensed Construction Supervisor: Not Applicable ❑ W, �2 nsed Construction Supervisor: r, , l �� VV u a o License Number mn Adds11L D/ 7 — Expiration Dateje S(j(hi4ire Telephone. r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name M Registration Number Addre 3 `� � Z Expiration Date ^ Sin re Telephone Y/ 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.......11 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: co/npI c_ 1 0ve- -zY- LLc��-T2�A/ Z?Ju 30,0�� /�� l�I�STC-2 7'�/cam �7�ro 1�x7-✓Y4S .�.✓� ��s•� � SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee D o Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC la D-5 Fire Fire Protection / 6 Total 1+2+3+4+5 Check Number SECTION 7a OW AUTHORIZATION TO BE COMPLETED WHEN OWNER CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/ ufhorized Agent of bject property Hereby authorize to.act'on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO.OF STORIES SIZE t BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS 1 ST2ND 3KDr SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DINENSIONS OF GIRDERS _HFIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE z The Commonwealth of Massachusetts Department of Industrial Accidents ' r d Office of Investigations Boston, Mass. 02111 5�lb Workers'Compensation Insurance Affidavit Name Please Print Name: SC1466rL C©..�S 1-iZu Location I© C-/ -u2 City �&_oGUa4,J ,r O� ) Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address Ci : Phone#: Insurance Co. Policy# Com n name: Address Ci : Phone#: Insurance Co Policy# Failure to secure coverage as reL rideron 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonmentaftiesln2hefnrm9f�-SIOPWORK_ORDER.and..afire.of.($1D0M)_slay..againstme.. I understand that a copy irwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify der p perjury that the information provided above is true and correct. Signature Date Z— Print name ( )OU 6n s SQ-_/e_622_ Phone#731 �ZOd Official use only do not write in this area to be completed by city or town official' City or Town Permit/l icensino Building Dept []Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person: Phone#: E] Health Department Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in.a properly licensed solid waste disposal facility as defined by MGL c 11 S 150 A. The debris will be disposed of in: (Location of F ilit Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector X�eli 85 7/ 332 \4 U1 14 2434 1 1 2 CC4 1 00 TOILET 6 0 L BATH 58 • 37 37 f' 1181 I lDwg no. dimensions&size designations This is an original design and must NONAME Scale: 1/2 1' Design: 06/05/021 THE Date : 06105/02 given are subject to verification on not be released or copied unless job site and adjustment to fit job EXPO applicable fee has been paid or job Louis Francoeur conditions. order placed. Designer r i 1�7- - -- `�-/,�tDuC.H EXQv_�Esr�_✓ �EvTc"2�_.�c�/�����_r�2�1�� I � _ • I i i i t i I �D X /OU') ► 1 I ✓1, om-m,9gmvetcl1. al BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR - Number: CS 067191 Birthdate: 12/26/1968 Expires: 12126/2003 Tr.no: 14359 - Restricted: 00 DOUGLAS W SCHEER 10 CHURCHILL RD ,� WOBURN, MA 01801 Administrator .r,� ✓fc {onmmarzulea�f� n�;.!>is.;rrc�«.�eC� r Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 128183 Expiration: 03/0712003 Type: INDIVIDUAL SCHEER CONSTRUCTION CORP DOUGLAS SCHEER 10 CHURCHILL RD. � WOBURN,MA 01801 Administrator NORTFi Town of And 0 No. /; 0 cocH,J c dover, Mass., d a RATE D O'f ,� y S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ko ff*R1N BUILDING INSPECTOR THISCERTIFIES THAT.... ..V. .e�.............. ................................................................................................................. Foundation has permission to sit 4Mo •.,�..... buildings on ...,��..... ......7k A:�, .ww„ ,,Y ,,,,,,,, , , Rough to be occupied as... ......... .. .r`OO !1.......�..N......... CZ1► . �.** *** ................44 I .................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and B�La1,9,3 sa0relating to the Insp tion, Alteration and Construction of Buildings in the Town of North Andover. ci ® PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST S ELECTRICAL INSPECTOR Rough 1110000.......... ................................................................................. 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. r ray Location No. Date i r l NO .o TOWN OF NORTH ANDOVER o�0•`t� •1NOOp „ Certificate of Occupancy $ Building/Frame Permit Fee $ . . --��V— �ss�cMusEt Foundation Permit Fee $ .� Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 25.04 PAID 93,y;J Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS PAGE ' MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE t _ _ ZONE SUB DIV. L07 NO. 1 — LOCATION PURPOSE OfBUILDING .. '- OW N[q'S NAME N� ''�'p NO. Of STORIES ' SIZE ..1 OWNER'S ADDRESS Z BASEMEN'ei OR 8IJ1B "��' :nG�•�..,� 2 ate n� ARCHITECT'S NAME — SIZE dF FLOOR TIMBERS IST •//f+ J�,A, .iJ2ND 3RO BUILDER'S NAME ` V �'A , SPAN —� DISTANCE TO NEAREST`B'JILDING `IY DIMENSIONS,OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SvDES REAR GIRDERS AREA OF LOT I3 a��® FRONTAGE � HEIGHT OF FOUNDATION THICKNESS IS BUILDIyG NEW SIZE OR FOt;TING �+ O x -31 IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION - IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFIRM TO REQUIREMENTS of CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 18 BUILDING CONNECT[D TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH BIDES .. ,. EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER Sq. FT. PAGE 2 FILL OUT SECTIONS 1 - I2 EST. BLDG. COST PER ROOM ELECTRIC METEPB MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED `\ r ■UILDINa INSPtCTop SIGNATURE Of NER OR AUTHORIZED AG T n ,1 F E E `OWNER TEL PERMIT GRANTED CONTR.TEL/ CONTR.LIC./ H.I.C./' ©L7� � PP. P t BUILDING RECORD 1 OCCUPANT Y 12 SINGLE FAMILY S'Ou1-S �.J THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICV,� LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUQ'',ION Q FOUNDATION fS IN/ RIOR FINISH CONCRETE CONCRETE BL K. -PINE _ BRICK OR STONE HAADN'D r PIERS 'PLASTIR _ .DRY WALL UNFIN. 3 RASEMENT AREA FULL FIN. B'M T' AREA _ 'L YI V. FIN. AT.FIC:AREA _ N_O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS 5 CLAPBOARDS B 1' 2 3 - DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HAROW O ASBESTOS SIDING COMIACN VERT. SIDING ASPH. FI IE STUCCO ON MASONRY ' STUCCO ON FRAME BRICK ON MASONWT ATTIC SYRS..6 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK, STONE ON MASONRY WIRING STONE ON FRAME 1 1 SUPERIOR_ POOR I_ AOEQUATE..I-i NONE 5 ROOF 10 PLUMBING ` GABLE HIP BATH 13 FIX.) _ GAMBREL MANSARD i011fT RMfflSINK — SLATE 12 1 FLAT SHEO WATER.' _ ASPHALT SHINGLES tAVA, — WOOD SHINGES KITCHENO PLTAR d GRAVEL STALL ROLL ROOFING MODERTILE FTILE D g FRAMING /1 'HEATING , WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. 6 COLS. HOT, -T'R;OR VAPOR . WOOD RAFTERS AIR CONDITIONING RAWANT H':1'G UNIT HEATERS G HO. OF ROOMS - - 5'M'T 2d _ ELE'i .RIC +' 13,d I NO nHEA LNG NORTH ToNvn of over No. 2 94 * _ _-_ ^N o rt . over, Mass., COC MIC HE w ICK AURATED PPC S� BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....................A--Sre�-- •.........-//J, ...............:.,...................... Foundation has permission to erect........ .. . --....... buildings on ........... ...:...... . Rough tobe occupied as................................................. .. C7`�`.''...............D... C�-........................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or, Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIONASTELECTRICAL INSPECTOR Rough .................................. ............................ :,.......... Service DING INSPE TOR Final Occupancy Permit Required to Occupy Building ` GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove,j Rough P Y P Finari- No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. 5 01 t3 U FFER ZONE 94.8 RD�..';�?, I' c A� 3- 2 'h4 r— ��r LOT 46 L 0 T 45 - 21 ,780 S.F. ScA o" ic N LOT 47 co 28,690 S.F. N 21 ,780 S.F. 17-72' I undation � 28. 18' As—guilt BERNARD E. I Fo&Ov-Cy97-O MUNRO SR. c; N No.34432 O l0 . 6.95 C 105. _t 5.00 � RIDGE—ROAD _ .. . . �� OS WIDE APP. WAYS -_•:.r1a�. t,?..._ . ... _ . _. SETBACKS:,,�F-20' S—o' R-20' (20' betty. bldgs.) FOUNDATION AS—BUILT LOCATED AT I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED LOT 46 ON THE LOT AS SHOWN ON THIS PLAN AND THE NORTH ANDOVER ESTATES LOCATION DOES CONFORM WITH THE FRONT, SIDE, NORTH ANDOVER, MA AND REAR SETBACK REQUIREMENTS SET FORTH IN PREPARED FOR THE TOWN'S ZONING BYLAWS AT THE TIME OF TOLL BROTHERS, INC. CONSTRUCTION. I FURTHER CERTIFY THAT THE 1800 WEST PARK DRIVE STRUCTURE IS NOT LOCATED IN THE SPECIAL WESTBORO, MA 01581 100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT LAND PLANNING TO BE USED FOR THE ESTABLISHMENT OF PROPERTY M49FIAL LINES, ERECTION OF FENCES, OR CONSTRUCTION OF ENGINEERING do SURVEY ADDITIONAL, STRUCTURES ON THE LOT. 187(660�ee�8-413�r x (508)9 6-505ItA 4 C'9 MAP NO. 0006C COM NO. 250098 DATE: 6/2/93 10-18-95 1"=40' 1 NAE-46 I JOB i Aft K. HOYLE CONST. CO. SHEET NO. OF Builder - Developer WEiVHAM, MASSACHUSETTS CALCULATED BY DATE Phone 468-4275 CHECKED BY DATE SCALE ............ N...... .... ....... ............. :... :... ...:... .:.......... ........ ... ...........: ...... ---•nom/--.r�� _...... .. .... ... j a ...... ...... ...... .. .. ] � a ....� y;.. f , GGG { T �:.. -�. .... ....... ............. ................ ... ....... . .y ......... ...... _ ._..................... .. ... .... ... ... .. .. ... ... VA ... ..... x ........ ..... .... .... ;........................................ .................................._ .:. .. .. ..._ ,.._ _ ..... �.. .. ._........ ........ ......_ .... ..........................:.......................................:.... ..................:.............. .. .. ...... ...... _.... ...... ..... ..... ...... .... ...... ...... ...... ...... ..... ..... ..... ..................................... ....... .,. ......`....... .:............:..............:........... .............:..............s............;..............;..... .................... ...... ..... ..................................... ...... ...... ...... ...... ...... 't; ...: .... ... .. i.............. ..... .... ... .... ..... . . .... ...... .... ..... .. ...,. . .. `� gg ... .... .... ... .. ................... . ..... .. h J ....._........ ...: _.. ...._ b.... .. .. ... ........................ .. ...... .. ... ..... .... ....................... r .. �' ... .... ........................... .. ids ..... .. .. .,,. ............. . . _. ... . .. ..... . . ... ..... .. . ... .. ... ....... . . --7r—747 .......... ............ .............. .......... ......... ................ .......... ............. . .......... ............ m .......... w .......... a aa O 0 0 .... ...... . ............. .................... ............................- ........... .............- ...... ............ ............ .............. .......... .......... .......... ............- ................ .......... .................... >1 co w CD .... ....................... ........... .... ........ z w yr i ............. ................. LLJ ........... w ............ ........... ........... co -j w U, < Cl) .......... . ........ ... .......... ..............— .......................... ........... ... ..... . ..... .......................... ............. .......................... ................ ........ .......... ............. G;mr ............ ........................ .......... LW ..... ...................- .......... U) 03: 14 ) ....................... ..... ..... WC co cn .. .........- .......... ............. ............ cl) .......... ... ....... . ........... ..........N ce ......................- < ........... ............. .......... ................ .... ........... ............. . ........... ........... .......... ....................... ............... .. .... -N ................. ............ .......... ............. .......... .............. .......... ........... ............... ............ .. ......... 77 Let- Location --• �- i064_WA No. Date N RTM TOWN OF NORTH ANDOVER c? � • oe „ Certificate of Occupancy $ + Building/Frame Permit Fee $ A"�d CM SS E Foundation Permit Fee $ � sus t Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 11 (,PC) A) Building Inspector •� 11/d/95 p95 09:49 1,460.00 PAID 8841 41 Div. Public Works Location Z �u�t��� Lot No. Date ! 0OR,M TOWN OF NORTH ANDOVER 0 • p Certificate of Occupancy $ ` y Building/Frame Permit Fee $ 00 sAcNus C eta Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL )- $ C-8--?, Building Inspector 09/28/95 13:04 150.00 PAID 8840 Div. Public Works Location_ No. Date 8-3o-9S o NORTM TOWN OF NORTH ANDOVER A Certificate of Occupancy $ + " Building/Frame Permit Fee $ s'A�M�S�� Foundation Permit Fee $ LO w Other Permit Fee $ f / Sewer Connection Fee $ � • c>. Water Connection Fee $ l� D TOTAL 40 $ 2 (-13, � 1 �j 30)'3-7 in9,tnspe . o" 49/28/95 13:R 1,043.50 8928 Div. PAtli^orks -3 r�lPs�'A` ���� PERAHT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP -NO. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE — ZONE SUB DIV. LOT NC t LOCATION Sf,A i= 'i v PURPOSE OF BUILDING s 6u OWNER'S NAME 5i YJ /.r {� N OF STORIES SIZE �6 `/��C�1GdV IGS % OWNER'S ADDRESS .3103 ` 1.. -• IE ✓ � SEMENT OR SLAB p�G ARCHITECT'S NAME ��Z/1 BL R�� LSTsf T SIZE OF FLOOR TIMBERS 1ST 77[� 2ND ✓r� 3RD BUILDER'S NAME SPAN IS DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS �1 DISTANCE FROM STREET �/ / " POSTS O14f DISTANCE FROM LOT LINES-SIDES �� REAR GIRDERS 'Lw G.�Q) y AREA OF LOT ^> ) ' �0 h FRONTAGE /�1Cr HEIGHT OF FOUNDATION ( THICKNESS /� IS BUILDING NEW aC LI [-1.�� SIZE OF FOOTING �)i/� X IS BUILDING ADDITIONW6 Tj,ii MATERIAL OF CHIMNEY 7-,;-zeJa 1 IS BUILDING ALTERATION IS BUILDING 0001-1D O FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE L/�Q r7 IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY !G/ IS BUILDING CONNECTED TO TOWN SEWER ��s IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY LAND COST (�' EST. BLDG. COSTd PAGE I FILL OUT SECTIONS 1 - 3 REGULATED BY PARA. 114.8-S. �•" EST. BLDG. COST PER SQ. . 6s�' PAGE 2 FILL OUT SECTIONS 1 - 12 -^ EST. BLDG. COST PER ROOM gS'FEE PAID �� SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDINGDATE SZ 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FIL AND APPROVED BY BUILDING INSPECTOR DATE FILED MU ILDINO INSPItCTOR SIGNATURE OF OWNER OR AUTHOR IZ T FEE ' .o C OWNER TEL.# ��8 6sa--ate PERMIT GRANTED 5-b PERMIT FOR FRAME/BUILDING CONTR.TEL.# r 19 cVc— DATE: Iti 3 FEE PAID CONTR.LIC.# C5 aq" MMIT FEE S SEP 2 2 LESS FDA FEE W&FRAME PERKY S- Ubna.._,. 8S� 1 BUILDING RECORD I 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 PIERS PLASTER ' _ DRY WALL —y- _ UNFIN. / 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/ 1/7 V. FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 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. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON F AME 11,7SUPERIOR OOR _ ADEQUATE I *�I NONE 5 ROOF 10 PLUMBING _ GABLE I HIP 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 11 HEATING I• -xr�- e15�F`••`�t, WOOD JOIST PIPELESS FURNACE t i+ •— { FORCED HOT AIR FURN. TIMBER BMS. & COLS. ortTEAM STEELS fC' %4) T W'T'R OR VAPOR ••° '� I �'�F WO IR CONDITIONING _. _ .�•i•� ..w...,, .., r■' RADIANT H'T'G UNIT HEATERS '7 NO. OF ROOMS GAS OIL B'M'T2nd �! ELECTRIC 1s-1 13rd - I NO HEATING w ', 11 ar f NORTH own oar 6Andover 0 No. 4419 ?, z —1�V o dower, Mass., � `�"' 19 Q A COCHICMEWICn ` 7�A0RATE D C'P�\ �5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .....koCOD...L1.nNOMt-t... �1 ......mow......................... Foundation has permission to erect.. ?1 ..... . . .ME. buildings on ... .........�...4.� r. ..W.4. .........."..... ...'4:/� Rough to be occupied as.. 1 '6UF...T)ttmu�4r . Chimney provided that the perso accepting this tshall in every respe t 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. PERMIT FOR FOUNDATION ONLI PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough PERMIT EXP IN 6 MONS FEE PAID Final UNLESS CONS UC -' " ELECTRICAL INSPECTOR T� Rough 1;:0 Service ...................... ........... ....... BUILDING I PECTOR Final Occupancy Permit Required to Occupy BuildingNSP R wl(kr' Display in a Conspicuous Place on the Premises Do Not Remove No ��';W Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. IRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �,( sic w00�l.j &46 Phone [9&12 02 LOCATION: Assessor' s Maio Number Parcel Subdivision Lot (s) q6 (Z StreetSt. Number SZ ************************Official Use Only************************ RECO DAT 0 S OF TOWN AGENTS: Date Approved Cona ion Administrator Date Rejected Comments 1,-E� ctill Date Approved Town Planner Date Rejected Cc=L , Date Approved Food Inspector-:iealth Date Resected r � Date Approved t 4q5 Inspec mor- ieaith �J� � Date Rejected Coro ents Publ.c Wcr:;s - se:ver,'water connections —l�� P,3045' - driveway permit Fire 0ecartment �d ce ved by Building Inspector Date SEP 2 2 94. 81 , 50` LOT 4(v zoNE' Z�, E8O s, F hN m 1 1 \ L_oT 47 �4 1 co / 343rSIV �S9 344 LOT 45 T� =34 7. O ��t�OF .Is 2(, + o p p � � NONAN �9a INS (36 =' 333J Zo \ A L 6. Z CPA o 9140.'1 p c m 1 d h E o P N v= ?g'? Y (50' WIDE APP. WAY NOTE: ALL UTILITY LOCATIONS ARE TO BE FIELD VERIFIED BY THE GRADING / SITE PLAN SITE CONTRACTOR. 10CAM At CoRNELI.. FE DORAL— LOT -44p SET BACKS F - 2. o ' s - v ' s - 2 0 ' - z o ' NORTH ANDOVER ESTATES NORTH ANDOVER. ILA war w� LAND PLANNING L3 -T7O— LL BROTHERS, INC. XNGBflM iG k MVEY UM WW FAM My =N 167 HARTFORD AVM BZLIZGFtAK 1u 02019 trs�'rsoIND. to omi (508) Odd-41 0 FA7l: (608) Odd-6064 5S 4o I NAE 4-(0 FROM LAND PLANNING BELLINGHAM PHONE NO. 508 966 5054 P01 50 JFFER ZONE�� �- -•1 . B lJ 94.81 i� - r -r• LOT 46 1 OT 45 � 21 ,780 S.F. N LOT 47 28,690 S.F. cly 21 ,780 S.F. tV 17.72' 38' Found CF c."L Foundation �. 28.18' As—guilt BERNARD U Novi•r.:fr MUNRO SR. A No.34432 0 105.00' RIDGE ROAD (50' WIDE APP. WAY) SETBACKS: F-20' S—O' R-20' (20' betw. bldgs.) FOUNDATION AS—BUILT - ---- _.. LOCATM AT I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED LOT 46 ON THE LOT AS SHOWN ON THIS PLAN AND THE NORTH ANDOVER ESTATES LOCATION DOES CONFORM WITH THE FRONT, SIDE, NORTH ANDOVER, MA AND REAR SETBACK REQUIREMENTS SET FORTH IN PWARW FOR THE TOWN'S ZONING BYLAWS AT THE TIME OF TOLL BROTHERS, INC. CONSTRUCTION. I FURTHER CERTIFY THAT THE 1000 WEST PARK DRIVE STRUCTURE IS NOT LOCATED IN THE SPECIAL WNS"NI R0. MA 014K1 100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT IfIffifflHop TO BE USED FOR THE ESTABLISHMENT OF PROPERTY LAND PLANNING LINES, ERECTION OF FENCES, OR CONSTRUCTION OF , ENGINEERING de G AVE ADDITIONAL STRUCTURES ON THE LOT'_ ts� tt00) O u 4130 $ effitntc 95 1[A o2ate (608) 988- 130 rA7L (WG) Sea-6064 MAP NO. 0006C COM NO. 250098 DATE: 6/'1/ys 10-10-95 1"=40' NAE-46 NORTH T -own of ar bove O �� ., ., to wu ,Y- ,A No. A19 ~ Y C, Tor> ndover, Mass., "' � o 199V oK CJC++�C nE K��tn � �A0RATEO BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDIN INSUqTOR THIS CERTIFIES THAT.kev- kv.4e ..... aCIC>o....L1.mvlm.ra...... 7� S t ..... wc......................... — t0 Lk oun ati n has permission to erect..u�1>.....rfQ+44%.. buildings on ... .....�'�t.f�6 ..1 4. ................. .... / Rough Gt'C� to be occupied as..21 .. �l�t. b....S,>� ....�...�1�(a+...5 ................................. Chimney provided that the persoh accepting this per it shall in every respo t 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. PERMIT FOR FOUNDATION 614 : PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough Final PERMIT EXI' IN_6 MONS_ FEE PAID ELECTRICAL INSPECTOR UNLESS CONS UU T __ Rough Service BUILDING I PECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P y P Final No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT y CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number y 7 5) Date ��z 7— THIS CERTgI,FIES THAT THE BUILDING LOCATED ON )e,( D Gor MAY BE OCCUPIED AS 5= IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. ° CERTIFICATE ISSUED TO AtWS V C"ON p ADDRESS '�sACNUS� Buil ng Inspector NORTH Town of 6 Andover o , �u�,Ir ��`Gls, VIA No. 44-1$ ►- } - o dover, Mass., Gin`V' Z 19 9 cOcmcMEWICK DRATED P �C 1 G BOARD OF HEALTH PERMIT T D Food/Kitchen G Septic System BUILDING INSPECTOR e THIS CERTIFIES THAT..kV-. a4K4; ..... O.000.... zw ............ ou ti 4 ............. 0[o has permission to erect.. �..... .!41rr__ buildings on ... ,....�4.Q6 ..lR?4.C.,�..........."'..... ....4/4<a Roug t0 be occupied as.21 Il 4 .�C.....����11��4rit �?1ca....4A� .... ... -�� ,...4�.. 9iq!A?E................................. C imney C provided that the persof� accepting this shall in every respe t conform to the terms of the application on file in Z final �� 3 this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of � Buildings in the Town of North Andover. PERMIT FOR FOUNDATION OigLt PLUMBING I SPE TOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. PERMIT EXP SIV_6 MONS FEE PAID _Loo d"b- ELECT R CAL INSPECT UNLESS V S UCTION START: �_ a �,� -(�' PERMIT FOR FRAM v RDUg ��-�c 7 f �_ .s:. ..... �..... ..........:.......... �`v: a ......... �\ Service /a' (C1 { / `/�i� DATE A _ G � FEE PA1Dy BUILDING )IN) E* 6k ma 116, Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough t [Cf G� No Lathing or Dry Wall To Be Done ARP PN Burner . Until Inspected and Approved by the Building Inspector. c FIRED V PLANNING -3WFTNA CONSERVATION N Street No.4 �,3 fL '. P 4z SEWER/WATER�/�Yr� W `FINAL DRIVEWAY ENTRY PERMIT � /►�� Smoke Det. �� �� • Date... 7. .�'•S 11 rn 2746 NORT1� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACNU`+� This certifies that .... . . ).... f W.......... A) le....................... has permission to perform ......111IL...<........ .................................... wiring in the building of.......... ... at L 1.... . .. ..f!.. .�^'� . ... ,North Andov r, s. LicfNiS—i O.:W E ECTRICAL INSPECTOR C �t 820A1/95 13:41 360.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File "t Office Use Only I 1: (ffom IInwml oMandRtfts Permit No. / lelrartmrnt of f lablk $ttfrtg Occupancy 8 Fee Checked IVA; BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3W peave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 1 :00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date AZQ QW or Town of NORTH ANDOVER To the Insp cto of Wires: The udersigned applies for a permit to perform the electrical work de ib d below. Location (Street & Number) Owner or Tenant s Owner's Address � Is this permit in conjunction wit ,a bui 'ng permit: Yes No ❑ (Check Appropriate Box) 1 r Purpose of Building �� Utility Authorization No. l,l(� Existing Service Amps _J V Its Overhead ❑ Undgrnd �❑ No. of Meters } New Service pAmps�_J_Z(LVolts Overhead ❑ Undgrnd lF� No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers I KVA Swimming Pool Above— in- No. of Lighting Fixtures i grnd. — arna. — Generators No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges �— I No. of Air Cond. / tons Initiating Devices � No. of Disposals / I No.of Heat TotalPumos KW No. of Sounding Devices j No. of Self Contained No. of Dishwashers / Space/Area Heating —1EVV Detection/Sounding Devices Municipal No. of Dryers �— Local—� I Heating Devices _ � Connection FiOther No. of No. of Low Voltage No. of Water Heaters I Sians Ballasts,— Wiring No. Hydro Massage Tubs 1 I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the reduirements of Massacnuseas general Laws _ I have a current Liability Insurance Policy including Comple perattons Coverage or its substantial equivalent. YES NO I have suomitted valid proof of same to the Office. YES NO = If you have checked YES. please indicate the type of coverage by checking the approppele box. INSURANCE OND �- OTHER = (Please Specify) (Expiration Datel Estimated Value of EI ctnca Work d� ,. 1 /1�/� Work to Start Inspection Date Recuestea: Rough G(/� C� Final Signed under the Pe ofry_: f GSC. LIC. NO. FIRM NAME Signature LIC. NO. �� Jr Licensee � f� Bus. Tel. No. C� Address Alt. Tel. No._A �e OWNER'S INSURANCE WAIVER: I am aware that the LfcWsee does not have the insurance coverage or its substantial equivalent as re quired by Massachusetts General Laws. and that my signature on this permit application waves this requirement. Owner Agent (Please check one) 16� Telephone No. PERMIT FEE (Signature of Owner or Agent) x-5565 Cc tf ����