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Home My WebLink AboutMiscellaneous - 524 REA STREET 4/30/2018 (2) 524 REA STREET / 210/03g.0-0317_0000.0 J I ; + Date..>... ..a..`. G.. . XORTst °ft :•�"� TOWN OF NORTH ANDOVER a ' PERMIT FOR WIRING �,SSACHUS� S /• VG ✓/ Thiscertifies that ............................................................................................. r r has permission to perform ..... .......E::.:. • - - wrong in the building of................................................................................... at..1`—'.Y—..-.... .....J `.!........:.... . —. ............................. 1j orth Andover,Mass. Fee.Ks..-.......... Lic.No�Gs %3."`/L..... ._I/� .r..V z..... ... :.... .. ........ .. "ELECTRICAL INSPECTOR Check # i 8970 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.F.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted 6y an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an firm or corporation stated on the permit application. Such entity shall be responsible for the electrical permit shall be issued to the person, notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of-ongoing construction activity,and may be-deemed-by the-inspector-of_Wires abandoned.and.invalidHhe—_. ._ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. C1 The Permit Extension Act was created by Section 173 of Chanter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. ermit/Date Closed: tl' *Note:Reapply for new perm' [O!PeUr7jmnitExtens1on Act—Permit/Date Closed: \ Ad Commonwealth of Massachusetts Official Use Only r ' 91F Department of Fire Services Permit No. 70 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(_7E ),527�MIj12.00 (PLEASE PRINT W INK OR TYPE ALL INFORA"TION) Date: QD� � t��` City or Town of: NORTH ANDOVER To the inspector of Wires: By this applicationthe undersigned gives notice of his other intention to perform the electrical work described below. Location(Streeteet&Number) _ -� t-� Owner or Tenant SIC Telephone No. Owner's Address 2 � Is this permit in conjunction with a building p�9�Y��o�Fj (Check Appropriate Boz) Purpose of Building 15"1 P©C2 -1 Utility Authorization No. Existing Service '10C) Amps /P1 / 2` "Volts Overhead ❑ Und d No.of Meters ©� New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �rC ef F-eh ley.—z� g(,k a C,4h to -7aG4 i Completion o the ollowin table m be waived b the Inspector of Wires. No.of Recessed Luminaires No.oECeiLE-SuEsp.(Paddle)Fans No.of TotalTransformers KVANo,of Luminaire Outlets No.oGenerators KVA No.of Luminaires Swimming Pool Above ❑ In- o.o mergency ig g d• rnd. ❑ Batte Units --, No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.®f Zones No.of Switches No.of Gas Burners No.-of Detection and Initis ' Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number ons K_W No.of Self-Contained Totals: ..._..._.____....._.._...._._......._. - - Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal A Connection ❑ Other No.of Dryers Heating . ppliances KW Security Systems: No.of Water No.of No.of Devices or Equivalent Heaters KW Si s BBallal of Data Wiring: Ballasts No.of Devices or E itivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: No.of Devices or Equivalent OTHER: 0 if y U Attach additional detail desired, or as require of Electricd by the Inspector of Wires. Estimated Value 1 Work: y (When required by municipal policy.) Work to Start c, /Zv/e 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 Er-BOND ❑ OTHER ❑ i(S ec P �':) I certify,under the pains and penalties of erjury, that the information on this application is true and complete. FIRM NAME: 601 ao-v( f0 �v( jvc� T LIC.NO.: Licensee: I rkw cl( v If(��l(c 'gnatute (If applicable, enter "exempt"in the lice number line.) — LIC.NO.: Address: �4 /11cc .4Ct �fcrq t/ 11�c vPr�.f 1 OII"41Q Bus.Tel.No.:Yl� *Per M.G.L c. 147 s. 57-61 security work requires D Alt.Tel.No.: ' ty q Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents i Office of Investigations S't U 600 N�ashington Street Boston, MA 02111 �� www_massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/individual): , �q Or Address: Q Aa h c5 pct �� city/state/zip:__ �a�e,��, 1. r l ?,4 6 3G Phone#:Q7 e&/ Are you an employer?Cheek.the appropriate box: L.❑ I am a employer with 4. [] 1 am a general contractor and I Type of project(required): ,,employees(full and/or part-time),* have hired the sub-contractors 6. 11 New construction 2. I 1 am a.sole proprietor or partner_ listed ori the attached sheet.1 7. F-1 Remodeling ship and have no employees These stL&contractors have 8. ❑Demolition working for me.in any capacity, workers' comp.insurance. q, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its Electrical❑ required.] officers have exercised their 10. repairs or additions ` 3.❑ 1 am a homeowner doing all work right of exemption per MOL 11 S7 Plumbing repairs or additions myself[No-workers'comp. c. 152, §i(4),and we have no 12.[]Roof repairs 1 insurance required.]t .employees. [No workers' comp. insurance required..] 13.❑Other ;Any applicant that checks bo)e#l must also fill out the section below showing their workers'compensation n,policy informatio t Homeowners who submit this affidavit indicating they are doing all work and then hits 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 infotmallon. I ant an employer that is.providinrg:workers'compensation insurance for my.employees. Below is the policy and job site information. Insurance Company Name: Policy 4 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 e. 152 can lead to the imposition of criminal penalties of a w 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 p penalties of perjury that the information provided above a true and carred Si Lure: Date: Phone 6`7,6 [[I. Boiard ciat use only. Do not write in this area,to he completed by city or toal wn ofc; or Town; Permit/License# ng Authority(circle one): of Health Z Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing lrtspector her act 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." r '' 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, MOL 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'#he 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 nurnber.listed below. Self-insured companies should enter their self insurance license number on the appropriate tine. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Departm&A 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 information if necessary)and under"Job Site Address"the applicant should write"all locations in_(cityor policy ( m'Y) aPP 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 Investi ions would like to thank you in advance for our cooperation and should you have an questions, . Y Y Pe Y Y 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 1-8.77-MASSAFE Fax#617-727-77499 Revised 5-26-05 www.mass.gov/dia Date...../. ... f NORTH, TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SgACMUSE� r This certifies that 19D ...- lJl/I ................, has permission to perform s...........L...4...../..�...x`�....l.`...�.�..�... ...... 5 � wiring in the building of.......WAO j........................................................ '5;4 "QF4 Sr ...........................,North Andover,Mass. C Fee. '� ... Lic.No. � p, f./_, ..........f ....................... ELECTR1TRIC�ALINSPECTOR Check # r . 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.p.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be fried on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G1 c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of-ongoing construction a jtivity,and may be.deemed-by.the inspector-of-Wires abandoned.and.irrvalidzf he---. _ or she has determined that the authorized work has not commeridd or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entitystated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic,recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. A we 8—Permit/Date Closed: j0 *�*Note:Reapply for new permit Extension Act—Permit/Date Closed: (,Ontn,onwaeLCh o/ Oficial Use Only Permit No. 7 4 _.(JalJar�n�o�Jirs�arvical Occupancy and Fee Checked BOARD,OF FIRE PREVENTION REGULATIONS [Rev. t/07] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All woc(c to be performed in accordance with the Massachusetts Eiect.-ical Code(itiIEC),527 CMR 12.00 (PLEASE"PRINT LV INK OR TYPE ALL INFORMATIOPY)' Date: 6-498' City or Town of: __AJ_A.t, Dao& To the Inspector of Wires: IBy this application the undersigned gives notice of his or heintention to perform the electrical work described below. Locatiort (Street& Number) �� R t� Owner or Tenant Telephone No. C332 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No t^1 (Check Appropriate Box) Purpose of Building Utility Authorization No_ Existi no Sc rico Amps / Volts Overhead n Undgrd ❑ No. orM4ters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location. and Nature of Proposed EIectrical Work: CLL r t p r rt t L2rr''I Lis-rem Completion o the following table m�Z be waived by the Inspector o Wires. No. ata No.ei Recessed Luminaires No.of Ceil:Sus P•(Paddle)Fans Transformers KVA No.of Luininaire Outlets No.of Hot Tubs Generators KVA I t Above ❑ n- ❑ o_o mergency ig.rtnrig. No.of Luminaires Swimming Pool Qrnd_ larnd_ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Cas Burners o.of Detection an No.of Switches r:itiatina Devices No_ of Air Cond_ oral No.of Alerting Devices No.of Ranges Tons eat ump um b e Kw o.of Se - ontaine _ No.of Waste Disposers Totals:I _ Detection/AIertin Devices S ace/Area Heating KW Local❑ Municipal 0 Other No.of Dishwashers P Connection Heating Appliancesy Security Systems.* -7 No.of Dry�rs No_of Devices or Equivalent - i o.o ester o.02 Data Wiring: Heaters KW Signs Ballast,; No of Devices c. E uivrlcnt No. of Maters Tetal HP a ecommun:cations Wiring: r No. Hyyd-romassage Bathtubs ,o.oDev:ce;'or E u:vale OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electri al Work: �� ti (When required by,municipal policy'.) Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVE GE: Unless waived by the owner,no permit foe 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 ® BOND ❑ OTHER ❑ (Specify:) I certify,under the paints and penalties ofperjitry,that the information on this application Is true and.complei FIRM NAME: S�GUtr1 Scram« LIC_NO.: K Signature' �-7 _ ' LIC NO.: Licensee: / (If applicable,enter"ez n pt"is the licen num�erli e.) r / /(1S uH Q. �9 Bus.Tel.No_: Address: X L 1�� JI /yam — AIL Tel.No.: G /9 *Per M.G.L_e. 147,S.57-61,security work requires Department of Public Safety S License. Lic.No. S' 'LG' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑owner's agenL Owner/AgentPERIYI3T FEE: S . Signature Telephotie No. ' Department of Public Safety One Ashburton Place, Rm 1301 Foston, Ma 02108-1618 License: CERTIFICATE OF CLEARANCE= Number: SS CC 001975 Expires: 10/09/2009 Restricted To: 00 KENNY WONG 18 CLINTON DR HOLLIS, NH 03049 Tr.no: 439.0 Keep lop for receipt and change of ada,-« COf�5fJ10Wr'►r. :LTH OF MASS-ACHUSE i I f DPS-CAI 0 50M-07/07•PC8490 ' .. .. �t.r� t; ,r_� Vii.1. :r.�•11 :! ✓rC Inornrtronvrxxrl(� nw��nunc%r,��(� LEC IA _ DEPARTMENT OF PUBLIC SAFE'',-Y REGISTERED SYSTEM TECHNICIAN '•i1 u CERTIFICATE OF CLEARANCE t5:J'aS THIS Ll:ENSE iQ . Number: SS CC 001975 • KENNY Q WONG . Expires: 10/0912009 Tr. no: 439.0 22 FIELDSTONE DRIVE S-License: ADT SECURITY KENNY wONG 13URLINGTON MA 01803—(42.13• 18 CLINTON DR // HOLLIS, NH 03049 Com mission-,-� DIG SAF'ECALL CENTER: (888)344-7233 5466 D 07/S1/10 284072 Comt :py=M. cav�niu.Jd: :+o• NUMBEllr DRIVER'S LICENSE . .t�i•e.'. •,.' DAtE Of1R�1�1 CLASS AFSI Nr10N1 SEX F :•i 1009-1969 D -r-07 Q%RES .. "•'' 0 09-2009 ' VVONG r f t • KENNY OIU �9 t;:.'• i 22 FIELDSTONE DR . I>0/•1K1 BURLINGTON,MA !! 01803-4217 r. V /r)r� t � t --- _ ----- DATE-- �- - -TIME-- - o p I CELL( ) II O FAX E nn Id E a — O E-MAILADDRESS AidTO itL-CANLF ❑ WAS N T PHONED BACK� CALL SEE YOU AGAI Date...... ..'... ............ NORTH °t� °;• '"° TOWN OF NORTH ANDOVER o ; p PERMIT FOR WIRING 19 This certifies that ....... �' `� P3 .. ......................... . g.7 .............................. has permission to perform ... e: 0 l� ...................... wiring in the building of.........,�. at.. IQy.....X<,q...........5. .~......................../Norths.Andover,Mass. Fee.. ............. Lic.No/? /t/-.... . •� �-... .�:.. .:. r7 " ,,.ssLECTRICAL INSPECTOR Check # �'�-� ISsU!!1llACJ41r/!!�¢71fblp Uff Y'116dg�611R.QBdd��66� � Permit No. �- d Services Department of Fire Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) APPLICATION FOR PERMH TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASEPRMTININKORTYPEALLINFORMATION) Date: G IZI ho 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 11 •2C.\ Owner or Tenant j-•( 6 \dA Telephone No. C��'25&' Owner's Address K C'�,S 533 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building �'f_ 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:' Uj \ t CJLr-iOL V t`t V,?— RA SG too vcl. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of TotalTransformers KVA { No.of Luminaire Outlets No.of Hot Tubs Generators ICDA Above In- o.o mergency ig mg i No.of Luminaires PLS (rl Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners �- - No.of Detection and �01-3L Initiating Devices Tot No. of Ranges No.of Air Conti. Tons No.of Alerting Devices No.of Waste Disposers Heat rP Pump Number Tons KW No.of Self-Contained " Detection/AlertingDevices Municipal Other r No. of Dishwashers Space/Area Heating KW Local❑ Connection No. of Dryers Heating Appliances KW Security Systems: No.of Devices or E uivalent No.of Water No.of No.of Data Wiring: Heaters KW Si ns Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors .Z_ Total HP Z /hy No.of Devices or Equivalent OTHER: -Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: CU (When required by municipal policy.) Work to Start: 10 O 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 siubstantial equivalent. The undersigned certifies that such coverage is in•force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE F / BOND ❑ OTHER ❑ (Specify:) X certify,under the pains andpenalt'es ofperjury,that the information on this application is true and complete. FIRM NAME:P F-�`v�-r, • G/eCNN Pk G2. LIC.NO.: I ZZ/09 Licensee: -t,,(- , �S -�c�v3� Signature LIC.NO.: (If applicable ent "exempt"in the lice a number line.) ` Bus.Tel.No.:6 J 61 V y5 2 Address: R-CyC ( L�6m /q 4 03 c)3 Alt.Tel.No.: *Per M.G.L c.147,s. 7-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's Owner/Agent PERMIT FEE: $ Signature Telephone No. P.7_Z, II The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 w4 sY• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): kr- r ' Address: Z Cc G�c Ac,t City/State/Zip: tQJtit� ,`n � fA'0 ,G3C27Phone#: SG_3661—CY YZ Are you an employer?Check the appropriate box: Type of project(required): 1.Eql am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction ployees(full and/or art-ti ).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.$ E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9_ ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 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 repalp insurance required.] i employees. [No workers' 13. therG� comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: 4 ��iP�� /'� U�-47-i Com' r Policy#or Self-ins.Lic.#: Expiration Date: 2[I I-��. 1 Job Site Address: � 7i� �� 5�� City/State/Zip:_ k G��1� �j tGt��.e(—/�' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).01 V 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 thepains a enaltie ofperjury that the information provided/'above its true and correct. Simature: Date: /Z /to Phone#• r-3 3.66 1 K-�/Sz 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#: 1 TOWN OF NORTH ANDOVER Of NCR. . qt "6 ••.•6 �0 Building Department ; 70 « � 1600 Osgood Street ,� o Building 2-Suite 2-36 Building Dept WAT.o.E< North Andover MA 01845 SACHUS Tel: (978) 688-9545 Fax (978) 688-9542 COMPLAINT FOR INVESTIGATION DATE: �I 3 TEL #: NAME OF COMPLAINTANT: �a A55 ANk-' ADDRESS: COMPLAINT TYPE: Electrical: Plumbing: Gas: Building: �Vroperty Owner: {.�� (Z p� S,"� . I N 0 f r�) oV (� Address: Other: k QQA—6,C4 N Signed: ' Complaint Form-Revised 6.2007 Date.1111 Of`NORT:��a TOWN OF NORTH ANDOVER a PERMIT FOR PLUMB*& ,ss'CMUS This certifies that . . . �.�/ .` . . . . . . . has permission to perform . .l S.t . I . .... . . . . . . . . plumbing in the buildings of . . . :J%... .r FF. l.� . . . .(. : .�. . . . . . . at . . . . . .f. U. . . .� r,. . . . . . . . . . . . . , North Andover, Mass. Fl.3L . .C,.Lic. No. . . . . . . .. . .": . . . . ... . . . PLUMBING INSPECTOR Check # Aj .o . MAS A CRUS TTS UNIFORM A.PPLICATION FOR PLMMIT TO Y?O PLUMBING (Type or print) NORTH ANDOVER,MA.SSACHUSETIS �a }Date <I �2A S Owners Name N e� Permit# _ Building Location Amount T e of Occupancy New � RenovationP Replacement Plans Submitted Yes No El - F)XTT) XS 00 off HH y H - - � yHy •� � d A ti�—1 � H •r�i� � � A � � W' F�1 _ 4� r7 SLB- MUM, 2MR C9 31�Q�+Il.7CR 5MFFLOCR 67 RO(R 7JHFLsOCR SIH PZiOC12 Check one: Certificate (Print•or type) Corp. Installing CompanyName�Y i I I� Q `"e�7' El 2 L.�da 6 Address c+v�/ U� �d� U Partner. - � Firm/Co. Business Telephone �e' +I5� 03 Name ofLicensed Plumber: I/0 I�� f Insurance Coverage: Indicate e type of insurance coverage by checking the appropriate box: liability insurance policy Other type of indemnity ,Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one ofthe above three insurance �i Owner Agent rgnature .- • red)in above application arC.truO an aG I hereby certify that all of the details anb o krand installationj have s erfoormed under Permit Issued for this application will be inte to best of myla�.owledge and all plumbing Cale and Cha ter 1.42 ofthe General Laws. compliance with all pertinent provisions of the MWas S Pl g p z By. rgna o kens um er Typee ofPlumbingLicens Title 3 H 4 I Joume an City/Town icense um er Master APPROVED(OFFICE USB ONLY - The Comnzmveafth of-Massachusetts Department-o f£xadustI.ial_4ccidents office 0f trivestigations Washington Street ` .�ostorz, ..1�1 f121'II ' wrt�w_a�rrs�g o�iditt . Workers' Compeusaizon zsuran.ce davit:]guiders/CantTactors/Elecfri,-aas/Ptumbers np�icanf Tx�fornaaion Please Print Leo-ibiy r Name(Business/Oro ulzation/individual): . Address: '� •Ge'�,f' b uvs� �� - City/State/Zip: r el/l C5 Phone#: •Are you an employer?Check the appropriate box: Type of project(required): . I.R I arn.a employer with 4. ❑ I am a gen eral contractor and I employees(full and/orpart iimej* have hired the sub-contractors �' eu�construction ? I am a sole proprietor orparfner- •listed on•tie aft�.ched sheet.T 7 Z Re odeling ship and have no employees These sub--.coinfractors have $./[]Demolition working for mein any capacify. workers' comp,insurance. [N o workers'com insurance. �. 9. ❑Brulding addition p. [� We are a corporation and its required.] officers have exercised their 10.❑Llectrical'repaairs or additions 3•❑ I am a homeowner doing all work right of er-emption per MGL I LEI Plumbing repairs or additions myself:[No workers'comp. c. 152,0-1(4),and we have azo I?Q Roof repairs i„anrance required.] t employees. [No workers' comp.mMAranc@ required_] I3.❑Other 'e-�-n3'�Iicr_f itygr):�?�s hox=�? m:'.°_a?sc,iu?c•�:•'L^e..evtie•n ce_cr..�:.,.,, _ . =^-s=^.^»;v✓crY.�s•comp>....s`oa^^rc FTomeowners who suumifiHs afdavit indicatingh , d r� J :cam t e3 e 2 aU•w.Tk and thea hi -Outsiete co�rraeto_s y?&t&u�.msc a new imdavit uodicafing such. • +C0ntraet0rs that cheeps this bog nz.q inched an additional sheet showing the ' aame'of the sub-contractors and theirwk oreis'comp.policy information- t am an employer that is providing workers,corrzpensatwn irm urance for my employees Beloit,is tie pork)and jobsite. LPLfOr71Lat2f}II, _ - Insurance Company Name: 4141 ✓p5 f4 Policy#orSelf--ins:Lic.#: E piration.Date: Job Site Address.--y �eA 5-�- City/3fate/Zip:A;,* A/0 C Attach a copy-of the workers'compensation policy declarati.4on page(shoyng the policy Aum.ber•and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the en imposition of criminal paltiof a nue up to$1,500.00 and/or one year imprisonment,as well as civil penalties in the form es of a STOP WORK ORDER and a zine Of up to 5250;00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DLA for insurance coverage verification, _ I do herebyeerti n'er the ains and ties afperjzrry thrzttre informaiion.provided above is true rand conec Signature: _-- .D.ate.:_•1 Phone# q: / 7Y - y��- <13 [0th se only. Do not wiiie in this area, to be completed'by CLt,or toren official Cityown• P erzaifLLicense# uthority(circle ones: f Health 2.Building,Department 3. City/T'own Clerk 4.Electrical inspector S.Plumbing Inspector ersozz: Phone'#: 97bS // Date.....(�--:..1�..-..��..�..... • NORTH °t'"`°:•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �sSc►ausf� This certifies that ................... ............ . has permission to perform ..............4./..T.G ....................................... wiring in the building of..................\.l,I..Q 1.i: ............................................ G atE!/......ST ............................ ..North Andover,Mass. Fee... . Lic.No..� .e,7 &4........ !-1.. ...... J!I..... F ELECTRICAL INSPEC.TbR 7 - Check # �� (,// {� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 7�-� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),5 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFO TION) Date: l City or Town of: To the Inspector of Wires: By this application the undersied ives not' e of his or her ' ention to perform the electrical work described below. Location(Street&Number) 2 L( k � Owner or Tenant Q e Ve- (,vo LF Telephone No. Owner's Address og rew z Is this permit in conjuncVion with a building permit? Yes T— No ❑ BLDG PERMIT# Purpose of Building H('7C er\ ke/ha d'C L Utility Authorization No. Existing Service 206 Amps H2O / 2140 Volts Overhead ❑ Und rd g No.of Meters 41 New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of thefiollowing table may be waived by the Inspector of Wires. 4 No. of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total. Transformers KVA No.of Luminaire Outlets 2 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig mg rnd. rnd. Batte Units No.of Receptacle Outlets /d No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Toils No.of Alerting Devices No. of Waste Disposers / HeaT tmp Number _Tons KW No.of Self-Contained Detection/Alertino,Devices No.of Dishwashers r Space/Area Heating KW Local❑ Con is tioal n E] Other No. of Dryers Heating Appliances KW Security Devices or E uivalent No. of Water No.of No.of Heaters �' Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: v O- Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �� (When required by municipal policy.) Work to Start: V V16 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 BOND ❑ OTHER ❑ (Specify:) I certify,under th pains andpe alties ofperjury,that the information on this application is true and complete. FIRM NAME: rtq�m(! v�/ f� LIC.NO.: 2aS93 f' Licensee: oAgf) 7'vA ft f,,o j Signature- LTC.NO.: (Ifapplicable, nter "exempt'in the li ense n,um�nber line) /�� Bus.Tel.No d /�/ Address: �a t/�S� �/ Nq✓<��C Alt.Tel.No.: *Per M.G.L.c.147,4.57-6 1,security work requires Department of Public Safety"S"Licen LIC.NO.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL 1.ROUGH INSPECTION: Passed—>d, Failed—[ ] Re-inspection required($50.00)- [ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 2.FINAL INSPECTION: Passed,: ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: fx —/� (Inspectors'Signature-no initials) r Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)- [ ] Inspectors' comments: (Inspectors'Signature-no initials) Date I 5.INSPECTION- OTHER: ; Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department oflndustrial.Accidents Office q fInvestigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: )3uilders/Contractors/FXectlricia>ns/PlumbeTrs Applicant Information ) Please Print Legibly Name(B.usiness/Organization/Individual): "ardy( 1/cv/'t/1 Address:_D D A4 9 A 4 City/State/Zip: qc w-e,-W L. Alg a 136 Phone#: �9 7�� 51! 6"7/ 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/orpart-time).* have hired the sub-contractors 2.M-I am a sole proprietor or partner- listed on the attached sheet.? 7• ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ 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.]i employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information._ T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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 isproviding workers'compensation insuranceformy employees Below is thepolicy andjob 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 of up to$250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify deir,49p ns and'penaldes ofperjury that the information provideld ab vfe iss rine/and correct. Signature: Date: l��Gl/ / U Phone#: ( -7 7 6 EOther only. Do not write in this area,to be completed by city or town official. n: Permit/License# hority(circle one): Health 2.Building Department 3.CityJTown Clerk 4.EIectricaI Inspector 5.Plumbing Inspector son: Phone#: 7454 Date..�/,/f f.1.1c...... R NORTh �3:Oy�.�o .e,ti00A1 TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SACMU5E�4� This certifies that . . . ::. . .`,. . . . . . . . . . . . . . has permission for gas installation . . . r (F,.. .. . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .t . . . . .. . . . . . . . . . . . . . . . . . North Andover, Mass. Fee. .xj. : . . . Lic. . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# l-LASSAa SEI'1S LNMRIVIAPPUCATONFOR MENU TO DO GAS FMING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS r Building Locations -5—,74 Permit# ,.� ^n Amount$� e- W B 1 (.� Owner's Name New❑ Renovation 0 Replacement � Plans Submitted ❑ a �a o a ° go �. o ti a z z O F' w W W ;n U 61 a v� z F E+ ;] r� t7 WH Z F z H 4 W U pOH G" z�+ r'� Cn x7 a7 O .1 U SUB -BASEMENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD. FLOOR . 14 T II . FLOOR 5TH . FLOOR 6TH. FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) C e Check one: Certificate Installing Company Corp. Address �� y ��• /(1�l�C� /.�� ❑ Partner.. 13usmessTe ephone f^rj Firm/Co.- Name irm/Co:Name of Licensed Plumber or Gas Fitter ► �/ �� r1h URANCE COVERAGE Check one: ve a current liability Insurance policy or it's substantial equivalent. Yes No ou have checked es,please indicate the type coverage by checking the appropriate.box. bility insurance policy Other type of indemnity Bond Owner's Insurance Waiver: Tam aware that the licensee does not have the Insurance coverage required by Chapter 1.1.2 of the :Mass.General Laws;and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 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 m} Knowledge and that all plumbing work and installation,,performed unrler Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts t: 1S Code ul apter 142 of the Central Laws. rBy: Signature of Licensed Plumber Or Gas Fitter e Plumber yiTown 0Gas Fitter tc ense 771 mer ' 0 Master:1PPROVED(OFFICE USE ONLY) Journeyman Date` ..../��. ....��.... * 'r' 1234 NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING MI � t - SACHUSf / S � This certifies that ....�.4.�.�.......�.....�....................14C �K (t...................................... has permission to perform Iftl'....... i wiring in the building of.....VQ. IR4 Y.R.1.0. !' at.....`S..�� ..... . .c .... r............................... .North Andover,Mass. r / q Fee.3 3�.C.... Lic.No!%. 1.. ........................................................... ELECTRICAL INSPECTOR i C, � 7 1�ii9/97 12.19 W5.00 PAID WHITE:Applicant CANARY: ui ing Depl. PINK:Treasurer i uhf: Lfommanistalth of Aiasaadprmfi Permit No. 01111:11111 une ottl,► � t • EtRin ttttttt of Public $nfttq Occupam A Fie ChecMd ; 3 BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 LM pare Wertk) � �.• APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date %* or Town of NORTH ANDOVER To the Inspector of Wlres: The udersigned applies for a permit to perform the electrical work described below. Location (Street s Number) Z- IZ eA- i � ; t I Owner or Tenant �0 0, A-,,'4 � O •, !� Cr ( N- f�✓U,i j 4,2 Owner's Address —Li /N ;. . IS this permit.in Conjunction with a building permit: Yes l No Q (Check Appropriate Box) f ' Purpose of Building Utility Authorization No. i Existing Service Amps -J Volts Overhead _' Undgrnd L: No. of Meters __ •~N New Service :2-0-D Amps 12dLJ 7-, J Volts Overnead �Ci" Unogrno No. of Maters j Number of Feeders ano Ampacity Location and Nature of Proposed Electrical WorK _Yy w e2 �{ •'�� Lt ,'. No. of Lignting Outlets I No. of '-lot ',:cs I No. of Transformers Total KVA ''•;' No. of Lighting Fixtures i Swimming Pcoi locus— in- r Srna. _ grno. I Generators KVA No. of Emergency Lighting No. of Receotacle Outlets (`� I No. of Oil Eurners I Battery Units No. of Switch Outlets No. or Gas _urners FIRE ALARMS No.of Zones y No. of Ranges I No. cf Air Ccrc. iOla' No. of Detection and 4 :cns Initialing Devices No. of 0isoosals I No.of Heat To:ai dial aurr.;,s :ons KVJ No. of Sounding Devices No. of Soil Contained No. of Oishwasners I SoacerArea .4eatir.a K%IJ OetectionJSounoing Devices No. of DryersI Heating Dev ces KW Local Other w Other �. t:OnnectlOn No. of No Ji Low Voltage No. of Water Heaters KW I Signs Ba lass wiring No. Hydro Massage iubs I No. of Motcrs ;oral HP rI OTHER: .i. INSURANCE COVERAGE. Pursuant to the reouirements of ma55eCGLsers ;eneral Laws h;• I have a current Liability Insurance Policy inctuaing Cc---:spec Ccerations Coverage or its substantial equivalent. YES NO = 1 have submittao valid proof of same to the OHics. YES _ NO = If you nave checKed YES. pUese indicate the type of coverage oy�' ' checking Ins app►f�lits box. INSURANCE = aONO = OTHER = (Please Scec:,�f) Estimated Value of E!ectncal Work S (Exbtratfon Dalai Work to Stan ��- j�� Insoec:lon Oats Aacues:ec: Rougn �^ Final Signed under the n&itiss ofe u _ P '1 rY� _ �^ FIRM NAME `S t Licensee /�C•Fr T�JM2 LIC.No. S f S g^a: re UC. NO Address us. Tel. No. <L� b 2 y? 1 Alt. Tel. Na. OWNER'S INSURANCE WAIVER: I am aware that the Licensee toes not nave ins insurance coverage or its substantial equivalent u re• r quireo by Massacnusetts General Laws. ano that my signature an :t:is zermn aopiication waives this requirement. r Agent (Please checit ones' � (Signature of Owner or Agentl {�`� ;:none No. ,._._ PERMIT FE !z' 41 0 aAt►fifi •� . Date.Qa �U g 3517 HORTq �,. •'�a TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ro1 SSACHUS� v �^ This certifies that . .J. . y . .g . . . . . . 4. . . . . . . . . . . . . . . . has permission to perform ) plumbing in the buildings of . v5c`T�/ , , 1ipfP/3Ac�'Iq'/ . w at. . . . . . ., North Andover, Mass. o d-tj $ ee3lP." �.Lic. No..9G.�.�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 1 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION:.FOR.PERMIT;-TO-DO'PLUf481 (Type or Print) . NORTH ANDOVER ,Mass. ate: Building Location z rmi # I � E Owners Name New Renovation j] ' Replacement 0 Plan Sa�lbmitted F TUR E z • Z Z , y a`o N 09 of O Z yt to Z ta % < a: a a: S cc a) x U. Z X 0. {� O m W el m S Q/ h U W O) x < N 0. � >< Z- ¢ C2 a �" w a W � n a 03 = c<c a Cre 0 w CC W O a W < ttl G ...t W c J til W Q U. a 1 w Z < r � o x x. �c a o � KC' x x < W lc X m < ~ < Q = G N N Q Q = SUS—,BSMT. a i BASEMENT /r 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STN FLOOR 6TH FLOOR t ,l 7THFLOOR �lV BTK FLOOR V/ t (Print or Type) Check one: Certificate / Installing Company Name� Corp. Address l�GL /a-yri Partner. �� G Firm/Co.__,�� Business Telephone �- Name of Licensed Plumber: 2a 'e4 01 Insurance Coverage: Indic;=.of insurance coverage by checking the appropriate box: Liability insurance policy indemnity ❑ Bond I I Insu a Waiver: I , the undersigned, have been made aware that the licensee of k th" a lication es n t hav one of the above three insurance co.verages. . • i S" nature of owner nt of property Owner gent`s I hereby certify that all of Ute details and information I ha.c subiniticd(or enletcd)in aho•c application ite Out:modttrste to Ute Ottt at usr - knowledge sod that all plumbing work and installations 1octfotnicd undct rctntit Issued fat this application wiU be in cantpllanos with an potlincol psq..4 visions of the Massachusetts Stale Plumbing Code and Chaplet 142 of 114o Ccnetal Laws, By If Title . signature of Licensed Plumber v ,y Plumbing License 9-1—M City/Town= __.__ ..__ ..... .,. ,_ License Number aStslC [] Journeyman . f J. CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Peemit Number ` Date 3 /2,0 Q r THIS CERTIFIES THAT } THE BUILDING LOCATED ON _ S ZR A -177 MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ADDRESS ''"""S` uilding Inspector 4 1 1 1 FN T x _ ovm Of -- :*, over No. 3 5po o_ " . dover, Mass., —195 LAKE '9-COCHICHEAICK yy.^`� C�44 E C 1 S r '-BOARD OF HEALTH Food/Kitchen PER M IT � T Septic Systjm � - c, ///K C � BUi�ING INSPECTOR TOR/�THIS CERTIFIES THAT................................:. ............, 4 Foundation As permission to erect,.............::°:....�.....Y.....: ::. br�llding on ...:...... .z-........... eA............C..... .................. Ro to be occupied as=f11 .. .�. ......... fl�. Chimney ./K..t...r. provided that tt pe�son.ahcepting this permit shall in every respect conform to a ter of the application on file in Final this office,l:and:#o the provisions of the Codes and By-Laws relating to the Inspe ,ion, Alteration and Construction of Buildi g rn.the,Town:of,:Nnrch Andover. PLUMBINP,INPEC ToR V10LIP01 N of the Zoning or Building Regulations Voids this Permit. ou 0 AGO EXPIRES IN 6 MONTHS 1 in �`� �-, UNLESS CONSTRUCTION STARTS ! T` KELEC ICS /SPE ...... . ..`l.. / ... . . ....... . � BUI ING INSPECTOR 11333 • 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. x• ; Burner eG�f t0 3 Street No. C, t troif Smoke Det. —ac- �� Locations No. Co y Date MORTM TOWN OF NORTH ANDOVER � 9 i Certificate of Occupancy $ Building/Frame Permit Fee $ s�cNu� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a 57 Check # 1 1. 3 ` 1 < ---- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, NOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING E BUILDING PERMIT NUMBER: DATE ISSUED: �n , n� X SIGNATURE: Building Commissioner/In for of Buildings Date Z SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ST fi , nl4joucla, 36 --,f Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning Dislrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RequiredProvided Required Provided 4 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record \ Name(Print) Address for Service: `V V Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Con.1truction Supervisor: Not Applicable ❑ W it ,-S Fo Y Licensed Construc'lion Supervisor: O )o ZePw; Grzf S4- License Number Mn Address d \f- L hwrLeNe F- t /-\)A . Q'13'43 C' Expiration Date Signature Telephone r G� 3.2 Registered Home Improv nt Contractor Not Applicable ❑ 0 Company Name rn Registration Number r Address r Expiration Date ^'Q Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......El No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: /—/)X T PL �Ls � � C -L r4 N I ( C,) SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Ix 0 Multiplier ` 5 2 Electrical (b) Estimated Total Cost of Construction �- 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as 0-1 er/Authorized Agent of sub'ect property Hereby authorize to act on My behalf,in all m s relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A ent Date w—1010010�11-- NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS iST 1ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE l FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. FOOOnOmmmmmm.mO. Oman ■......................■mmOOmmna.O..mmOa.OmaaOmOOmnmm■ APPLICANT R�'� PHONE ��.5 ' 0cP y� ASSESSORS MAP NUMBER C LOTNUMBER V� SUBDIVISIO/NN LOT NUMBER STREET / `� STREET NUMBER � OFFICIAL USE ONLY REQQhM1ENDjkTI0NS OF TOWN AGENTS l■ . . ....0.. ....y........................................a onto O .�.y.^�..... DATE APPROVED SCJ K1 CO ERVATION ADMINISTRATOR f/ DATE REJECTED COIyIIvIF.NI S DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPE R-HEALTH DATE REJECTED DATE APPROVED p a IN OR-HEALTH DATE- REJECTED CONNM ENTS Z iw i-, C� PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CONN ENI'S RECEIVED BY BUILDING INSPECTOR DATE Y 7 � �1cc [oamvea1�o��ias�i�cveltYs i BOARD OF BUILDING REGULATIONS i 1 License: CONSTRUCTION SUPERVISOR Number. CS 058663 Birthdate: 05/1111955 Expires:05/11/2002 Tr.no: 24414 Restricted To: 00 j CHARLES A FAY JR _/ I 20 BERESFORD ST LAWRENCE, MA 01843 Administrator d I HV UUIIIUIUIIVVCdllll UI /VId66dUIIUZi US Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name' f�VLI T Location T2 q City �- 4A�dye,,--t 1`14 Phone 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. Companyname• Address city: Phone#: Insurance Co. Policy.* Company name: Address City Phone# Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify andr the pains and penalties of perjury that the information provided above is true and correct A C71 Signature Date .1G-/G ^GO Print name Phone# Official use only do not write in this area to be completed by city or town official' Building Dept ❑Check if immediate response is required Building Dept p Licensing Board F1 Selectman's Office Contact person._ Phone A- 0 Health Department Other FORM WORKMAN'S COMPENSATION Town of North Andover of NORTH �tL=U �? yt , »,• 6 0 Building Department o 27 Charles Street North Andover Massachusetts 01845 _ .� �► 978 688-9545 Fax 978 688-9542R4TID 7,9 SsgcHus� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and.a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, s150a. The debris will be disposed of in/at: Facility location Signature of Applicant 00 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. JOB ES FAY CONSTRUCTION 20 Beresford Street DATE PHONE LAWRENCE, MA 01843 j "'? o u ? ` (508) 975-0242 JOB NAME/LOCATION TO: oL TV,I%A— !`1"^"'" ^ C� L ✓"/ �'!D/ICO r• ® J O B D E S C R I P T I O N e G,, x „ ")OCItt S'G4ulL 0 �Cv 0-0 C.oN,S4 Jr_4 WALL ShCoiNuet,. f imtsh 4 f L4 nao 1300 �o Ura a� 6-� IC' I d �. I crut is 7 �"wic. + c( &j ° aGf/ i � I I ! r'rzw.,T 4- INS Ec11_ aN This estimate is for completing the job as described above. It is based on our evaluation and does not include ;- 7 ST material price increases or additional labor and materials JOBlCOST C Jmit which may be required should unforeseen problems or adverse weather conditions arise after the work has started. ESTIMATED BY FORM 714-2 McBee.1055 EAST STATE ST.-ATHENS,OHIO 45701 To Reorder Call Tell-Free 1-800-526-1272 DUPLICATE off, �a r slrvl_, WE DOHERTY E 1 1 97 S 4 51 51 u PRH HOk E 01 rh v. A14 ti gni-10 yko At, 00 41 t i4 loz o r 1,=,z 4,v 4dAA4eAW -Z' Cdrer."W-e ^"-y- -W& OAPlr4,e1A-W Af.AAdr oar ell'a4vr.0 'w 4re~ RUAlee A ® o 2 � � ��• 1 rt o� 1` • �-EA �7't2 E�t AS BUILT PLAN OF SUBSURFACE' DISPOSALOCATEDI L SYSTEM N AS PREPARED FOR J. Bo.R-P��,�.Lo • DATE: `7EPT: 3�, 1,9,9-7 SCALE: I '- 'rL LZ' NORTH Town of over. 0 Co �A CoCM CHEwo dover, Mass., DRATED BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT.........+F.. .. .. .........A .I.. /�,..... ................ .................................................. BUILDING INSPECTOR Foundation I has permission to erect..... .... .07.a..... buildings on .... .. .Y...............r*4......... .�.............. Rough to be occupied as.......... G�� X��N N 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. /V 8 g P 4?'07 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ......... . . .....�....................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT Street No. SEE REVERSE SIDE smoke Det. \ 1 ' � `� i R �a 0l �l7Jn 'UoO� i�gi r ITT�P—Y /'i74D]J�M �N✓iM3 j Ec- FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that allnecessary approval/permits from Boards,and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT �' ��'P—� PHONE /'75 06� 7 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER C` rl-,D STREET STREET NUMBER ` T OFFICIAL USE ONLY ........................................................................... RECOMA4ENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPE R-'HEALTH DATE REJECTED DATE APPROVED�,[7 a a IN OR-HEALTH DATE REJECTED CONOAEN IS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CONQvIENTS RECEIVED BY BUILDING INSPECTOR DATE --------- x F — PE K A Tr 4� 3 '7 D -- LOT NO. 2 RECORD OF OWNERSHIP IRATE (BOOK =PAGE 0. SUB DIV. LO / • I zov4 LOCATION Tr PURPOSE OF BUILDING OWNER'! NAM[ NO. OF!TORIES 112E Z X r OWNER'! ADDRESS BASEMENT OR$LAB O a OWNER'S OF FLOOR TINDERS IST ZXID iNO�X 3RD ARCHITtCl-S NAM[ zov BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING ��/ DIMENSIONS OF SILLS 2 X POSTS DISTANCE FROM STREF( / GIRD - DISTANCE FROM LOT LINES—SIDE! O REAR GIRDERS /— NIGHT OF FOUNDATION �j / TNICKNCSS l� / AREA OF LOT 41377 / 3 7 3 3 FRONTAGE �� a If BUILDING NEW r�(`�^ S12[OF FOOTING ZO�/ x 19 BUILDING ADDITION MATERIAL OF CHIMNEY r� IS BUILDING ALTERATION If BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENT! OF CODE ' IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY ----------- I! BUILDING CONNECTED TO TOWN S[W[R G(J� I0 BUILDING CONNECTED TO NATURAL GAS L:N3 3 PROPERTY INFORMATION INSTRUCTIONS LAND COST 5 5'-j SEE BOTH 91DES CST. BLDG. COST / EST. BLDG. COST PER w. PT. PAGE 1 FILL OUT SECTIONS 1 - 3 J f/ U GOT. BLOC. 001T PER ROOM PAGE 2 FILL OUT SECTIONS I - i2 /�"�'.tN7 B9PTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING �/ 4 APPROVED BY ATTACHED GARAGE!MUST CONFORM TO STATE FIR[ REGULATIONS CLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR / BUIINC SPECTOR DAT[ FILED /1GNATU OF OWNER OR AUTMO D AGENT OWNER TEL.#k �Z ZZ FEE ,K.-RwI1T f EE . CONTRA.TELL �8� Z- tT[IIMiT aRANTEO �E - s FRAME PERMIT� coNTR�,.uc.k i H.I.CA .w F._ ..:. • .. ct 't . .. �. .j' .. _... �. T" a _ a� , Y -r'�'6i.!i.1.'3 "t" _ .. - _ K' � y r Y � I:��t:f�,s3s��i� �3 r�� Tt�l�r`►3��.�� Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applican n Bull ing Permit a w) Address of Property for Per (below) �r � ��-� 5-6;- - Map and Parcel : Pur e of Ap ication (check below) Phone Number of Applicant: = Ingle Family _Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the { above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement,restoration,or reconstruction of a dwelling in existence as of the effective date of this by-law,provided that no additional residential unit is created. The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals,where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents,where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section"senior"shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density, (buildable lots), below the density,(buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or th checking off of an above item which does not comply,whether done to my knowledge or , is grou for refusal by the uilding Department to issue a Building Permit. Z -AA-Z2 --�7 Signaturelwff who signed the Attached Building Permit Date This f7fi must be attached to thfiVtuilding Permit upon application for such permit. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this segtion***************** APPLICANT: �r.r /s�r�i'- �� Phone Q9 <f __-<-/ LOCATION: Assessor's Map Number Parcel Subdivision _ - /� - Lot(s) Street St. Number Z� ************************Official Use Only************************ RECO, D IO WN AGENTS: Conservation Amin' Date ApprovediLiJi is rator Date Rejected I1t 5 Comments �M� l�� Town Planner," Date Approved Date Refected Comments Food Ins ector-Health Date Approved Date Rejected Date Approved is �Spetor-Health d — Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department r'1/ : , P sv1�ir1 Received by Building Inspector ?.a,,#%-� it-r Date i Y ' 11ONNM of c - dover o - rn No. 3 XPO s . dover, Mass., 0 LAKE '9A_C OCKICMEWICK LY',• / OA?4 E p pp%y �G BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT........................................... BUILDING INSPECTOR ............A.U. A9,4.110................................... Foundation has permission to erect......................(................. buildings on .......... .Z-..'f'.........n. a p............�.... .................. Rough tobe occupied as............................................... .. .t, ..........�14.f.'�..(... .1, ............................................ Chimney provided that the person accepting this permit shall in every respect conform to the terrr;� of thea lication on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspectio of ion and Cons r Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATE[) By PARA. 114.8-S. B Rough Final PERMIT EXPIRES IN 6 MON F PAIS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .............................. ..... ......... .. ..... .... ................................... Service BUI ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a ' uous 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. Smoke Det. "own ot over No. 3 dover, Mass., 19 9 O - LAKE '9 COC OI S E BOARD OF HEALTH PERMIT T Food/Kitchen Septic System ��- �! BUILDING INSPECTOR THIS CERTIFIES THAT.................................................. ...............L � .'� ��................................... Foundation has permission to erect......................(................. buildings,on .......... .z-. ......... . ............ ..T................... Rough to be occupied as.............................................. .. . .......... Chimney provided that the person accepting this permit shall in every respect conform to the W46-6--e- erra 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST4RT1 Rough .............................. ..... ......... .. ..... .... ......................................... Service BUI ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F nagh No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Classic House Plan # 1339 = 1 .1069 Cedar Realty Trust 25 cedar Sfi- eet N . Reading, MA 01864 508 - 664 - 9448 16 ao 10 EMI N Uamil 1 7 ° o 28 X 40 COLONIAL 4 BEDROOMS - 2 1 / 2 BATHS - 14 X 26 FAMILY ROOM - 3 ,008 SQ . FT . t .1 L I --F I -T i I I N -T- I I- I LX I I I I I I I I I 'irrrrrrrrrr!lr7j r- ::I- r- I -I- I -T- I -F -4 i I -T- I -T- I --F- I --F- I -T- I K- I I -T- I --T- I I I I I -T- I 4L I -T I -T- rl�l�■!`r � .rlrrrirlrlrlrllll�i.I I I I 1 -1 1 1 1 JN. I -T- —1 1 -T-% I I I I I I I I LX 1001 1 1 1 1 1 1 1 1 1 1 1 1 t 1417 F� • Aw-c 'oe 2 ILL LL The D.L 10 lbe FM EE H 1. 11 ED II■ITH Secord 7 L.L D.L,,10 The FFFIS4 LLDI -_LLW ff LLJI __ - ■1111. _ _- ■�■ _- Fht- 1HE IL■J1 .1 40 The P.L-10 lba J- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ONT ELEVATION- 13313 - 1 MI — ■■■, _ ■■■; _ 1 0 '21 o ... 'm ow ■■■ 0 INME :inns anat I OEM ■■■ ■■■ son — III ■■■ --_INC �I��■ ■■■ ■■■ ■■n ■■■ ■■■ ■■■ ■■■ ■■■ ■■■ ■■■ _ ■■■ ■■■ _ ■■■ Isom . _ maximum ■■■ I■■■ --,oil Moil IL �� II, _ — 54'0 27,8„ 4,8,1 4,8„ 3,g„ x,13 21611 31011 �,9i�4,� 10'634 a 1314" 2'10" X 3'5° 3'4° 10 X 10 DECK -c14 "' N 2'10' X 419" O ---- wou►-t----- 6'O" SLIDING LEN cp ' STUDY a = o X ,p �GITC�-�IN L O o 160 BREAKFAST i C4 24 X o � - cil N ' �, • , ' 152/2 n — Post ° FAMILY ROOM2'Su 21611 o 0 O ``' n �. r7 _ _ Z -0 111 Post o - .: a� = Post j? LIVING ROOM .� X DINING RM n _ FOYER m 210 X 5'5" 2'10" X 5'S° 2'10° X 5'S" Z'!O" X 5'5° t11'41,4„ 2,1p„ X 5,5„ 2'10„ X 5,5„ O n CL. 4'0•• 6,0„ 4101 316„ 3,6 „ 4,0„ 6,0„ 41011 3,6„ 10„ 3,6„ 141011 2,611 ,7,0„ 2,6„ 14,0„ 40,0„ 14'0 , -FIR 1 PLOOR FLA N. 13313 - 3 3/16" = I'O" 54'0" 14'93/4" le 6,61/Zu Wo If to 1113/411 5�C3 9'03/4 310" 4'& 4101'x Z,61� 4'0'• TO ►� � 2110" 315" ------------------ ZIO 35 Z1 0 45 F=x5 415" o Z E- ;.� Q� _ �n UJALK-IN Lr% 4 ? 3, o M BATH ° a � CLOSET , a C _ �D � #'¢ 5�3�2Zi03'S��sm '424 U = — �4 Z'6° Zebu v 2.b.. 22'6 �0�, `r in v Post '10 31( 1 3.6.. '��tiZ" �; ;CL,; X O � ��. N 2b ip c4 Post _ n 54"44�� 3�6�� o ,�„ M $ DROOM N 26 z o $EDROOM #3 0 OPEN BEDROOM #2 2Li TO - BELOW n 2'10" X 4'5" 2'10° X 4'511 2'8" 2'10" X 4'5" 2'10" X 4'5" 2'10" X 4'5" 210„ X 4'5" O N N - 4V 6.0.. 410•' 6,0 410 4'0•• &'0 it 41011 101 31�If 0.. �a:0'• 14'0, 14' 40'0" 1410" FLOOR FLAN 3/16" 1'0" 11339 - 4 13 lb'2 r ----------- --------------------------------- ---------------- ----------------------------+ + ►• r-------------------------------------------------------- ------ -'r-�- + o ; FOUNDATION GARAGE FIN16H �� All wood constructed walls and ' -- 10 Concrete Wall / 8 0 Pour ' 10" Dp x 1'8" W Cont_ Footing ceiling to have 5/8" type 'X' Fire -a rated Wallboard installed ' Com' t2 il OV �0 �0 � 0 Mr— !rj I I p , l if O , • � � �-� -• III i I�t--,_- --* " _ ' - Lally Columns 31/2 Dia - � �► � >- III m � " „ p , , r 1 I_I With 2 b Sq, x 1 O Deep ' BEAM POCKET -+�- Footing (9 rcq'd) b" W x 6" DP x 9" N — 3 - 2 x 12 Center Bean .� �� I o ' Shim beam with steel - 4 Concrete Slab ; o O .., 6hims or hard brick Slope VIS° per foot i o '� .► ; U Req d? u m ►. , Q , 1 4'(min) Step down Into an —� 20 minute fire•door (min,) ----------------- IF IF _ _ ! { + + -------------------------------r-----------------r-------- - - --------------- + ---------------------------� O + r g Los ---------+ r---------+ r------------------------- - ----------- ------ - I , + - + n _4. 14'0„ 'Z 2�6„ 14'd„ 14'O„ B4'0" -FOUNDATION PLAN 133'3 - 3/ib" = 11011 LU Allmember*are 2 x 10 "O.C.ILI.N,O.J I/B".pp■ u m v u Flush Framed Seam a All membero are 2 x 10 9 I6"p,C,a .NA,1 ' !/B". 110 i Flush Framed Beam Fiwh Framed Sean I i i i i MI All members 2 x 10 ,10 16" O.G.U N.0) ATTIC FLOOR FRAMIN VS" • i'O" 1111 fill 1111 111111 till '00 2 x 12 Ridge Board 2 x 12 Ridge Board All nemben are 2 x 10 9 16" O.G.U N.0) Nip t valley rafters are 2-2 x 12 ROOF FRAMING 1339 - � 1,8° • 10 Continuous Baffled Ridge vent 2 x 12 Ridge Board r I x 8 Collar Ties fV 4'0" O.G. 12 10 RODFINCx Composite Roofing Building Paper Sheathing 2X106vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv16" O.C, O , CEILING E—Fascla Hoard 2x5616' OL. R30 insulation Overhanging soffit vapor Harrier with venting 1/2' Wallboard, FLOOR 3/4" Sheathing WALL 2X10Ql6" OL. Siding,Air Barrier - Sheathing,2 x.4 19 16" OAC, Insulation,Vapor Harrier 1/2" Wallboard m FOO 3/4" Sheathing - SILL 2 X 10 6 16 OL. R20 insulation 1 - 2 x 6 P.T., I - 2 x 6 K.A. I 3402 .8 .4 Continuous Sill Casket e. V2" Ata. x 12' Le. Anchor Bolts 2X Fire Blocking 6 8'0' O.C,(max) 3 2 x 12 Center Beam - 3 UZ" Dia.Laity Columns FOUNDATION - 10" Concrete Wall / 8'0" Pour Cz 10" Op x 1'8" W ConL Footing Dampproof exterior surface 4' Concrete Slab WOU.S;= A E C T I O N 1/4' _ 1'0�� - 13313 - S Contlnuoue Baffled Ridge Vent 2 x 10 Rldge $oard I x 8 Colla Ties 0 4'011 O.G. 12 -- -- ROOFING 10 Composite rooting Building Paper Sheathing CEILING 2 x 8 6 16" OAC. 2 x i0 -A lb" OZ. R30 Insulation =� vapor Barrier V2' Wallboard. Attic -- Fascia Board _ - L.L.• 20 !bs 10" Overhanging Sofrlt with Venting FLOWALL 3/ SOheathin Siding,Air Barrier 2 X"10 9 I6 Sheathing Second Sheat in ,2 x 4 9 I6 O.C. Insulation,Vapor Barrier - - 1/2" Wallboard _ - LL,= 30 Ibs s D.L.= 10 Ibs Sp m FLOOR o 0 3/4" Sheathing 2 X 10 Q 16" O.C. o RIB Insulation iY irgt SIS - - 2X Fire Blocking I - 2x & P.T.,l - 2 x 6 K.D. LL,=40 Ibe g _ Continuous Sill Gasket D.L. = 10 lbs 1/2' Dia. x 12" Le. Anchor Bolts 3 - 2 x 12 Center Seam 6 8'0" O.C. (max) 3 1/2" Dia. Lally Columns FOUNPATION _ T 10" Concrete Wall / 8'0" Pour V- 10" Dp x I'8" W Cont. FootN 4" Concrete Slab Basement SAE(10.0" TION TPRU P 1339 J 114n 11011 10 IDECK , ------ ------- ►'O" D-a, concrete P-ter Stair location, number ; 3 of risers and treads ' may vary due to CP O 2 x S na YO Off. site conditio+w. ; O (P Joist danger (typ-) o � - � o 0 0 0 0 0 y X 8 Ledger Lag bolts a ib" O:G. K FRAMINa 114" = 1'0' Flashing Lag baits Qa 16 0-C. I&' Clear(Max) Rail � Decking l=ost ---�-2x Deck framing tr T) O 3 - 2 x 10 D Joist danger 6x & Post D. Post Anchors - Concrete Foundation Grade �0 co NN-E cMlo E 1i2" = 1'0" U4' = 1'O" J016T/RAFTER 6FAN6 - HEADER 51ZE5 - LALL%I" COLUMN 5PACING MAXIMUM ALLOWABLE SPANS FOR HEADER e MAXIMUM ALLOWABLE SPANS FOR SUPPORTING WOOD FRAME WALLS JOfSTS/RAI=TERS All, Span of Headers Dee(gn 5>ze of Wood Supporting one Story Two Stories In Garages or in Walls f=loor Span 12' 13 14' 15' 10' Deader Roof Above Above not supporting F=loors or roofs FIRST 2 x 8/12 2 x 10/16 2 x 10/16 2 x 10/12 2 x 12/16 2 x 10/16 2 x 12/16 2 - 2X4 4' 6' 2 - 2 X b 4' tob' 4' b' to8' 2x8/12 2x10/12 2 - 2 X 8 6' to 8' 4' to 6' 4' 8' to 10' ATTCORMIR-F Rooms ND 2 x 8/16 2 x 10/16 2 x 10/16 2x10/16 2 x 12/16 2 - 2 X 10 8' to 10' b' to 8' 4' to 6' 10' to 12' 2 - 2 X 12 10' to 12' 8' to 10' 1 6' to 8' 12' to 16' ATTIC 2 x 6/16 2 x 6/12 2 x 8/I6 2 x 8/16 2 x 8/16 xo FUTURE ROOMS 2 x 8/16 ATTIC 2 x 6/16 2 x 6/16 2 x 6/16 2 x 6/16 2 x 6/12 CAP=S 3A2 OR L=66 2 X 8/16 TRU55 ROOF 2 x 6/12 2 x 8/12 OVER ATTIC 2 x 8/162 x 8/tb 2 x 10/16 2 x 10!16 2 x 10/16 TRI.155 l0Pl CATHS-DRAL 2 x 6116 2 x 8/12 2 x 10/16 2 x 10/16 2 x 10/12 30 PSF 30 PSF 2 x 10/16 2 x 12/16 40 PSF 4o P51= 1 40 PSF 4o PSF JOISTS/RAFTER SPAM NOTES: 1. Span Tables for- First floor joist 13405-2 1 ,Sc l� ( Girder Second floor E useabie attic joist I 3405-1 I W Attic (no future rooms)13406-13 Caejot 1 C� I CA5� CA�I1I CAS IV Roofsaic ot erloor atttics Iis34o6 b 12I Cathedral Roof Rafters 13406-3 I COLUMN SPACINGS UNDER GIRDERS 2. Maximum span for 2x 8 ceiling joist for cape attics is 19 Il" 13406-2 3 . I Table 3405-6 1 r irder size 3 - 2 x 12 5-13 5-14 5-15 S-16 d = 1000 CASE f 6" 9'-1" CASE 11 8'-8" 8'-P' 8'-0' CASE III i-o" CASE IV 6'-9" Column sizes - 4" x 4" or 3 1/2" diameter steel Footing Size - 2'-6° x 2'-6° x 10lid 5TANDARD NOTE5 GENERAL NOTES- SECTION GENERAL NATES rOIINDATION GENERAL NOTES { 1. All dimensions are to be field verified by the Contractor and any 1. Floor design live loads and based on 1st Fir @ 400/scT. ft., 1. Concrete slabs on grade shall have contraction joints with a depth adjustments made accordingly. 2nd Fir, a@ 30#/sq, ft,and nonusable attics Q20#/sq. ft of at least 1/4 the slab thickness.These shall be spaced not more than 30 feet in each direction.Contraction joints shall be laced where 2. All work shall be completed in compliance with all applicable Roof design loads are 30#/sq. ft. live load and #/sq. ft.dead load, j P p p app offsets are more than 10 fest, Building,Plumbing,Electrical codes. Any other local, state and/or 13405 . 1 4 Table 3406-6 1 Contraction joints are not required where 6 x 6-6/6 welded wire Fabric federal codes that may apply to this pro ject shall be considered as 2 Minimum ceiling height for habitable rooms is 13". in a room with a or equivalent is placed at mid-depth of the slab.13408 ,3 . 1 , 13 art of the construction documents. P sloping ceiling the prescribed ceiling height is required in only one half 3. Ali waste materials shall be removed and disposed of properly of the area of the room. No portion of the room measuring less than 8 feet 2, the ule not compressive strength , ft,13402 ,2 , 11 concrete Foundations at 28 days 4, Numbers set within I 7 reference that section of the Massachusetts Finished shall be included in calculating minimum area 13401 .6 , 11 . shall be not less than 2p00 1bsJsq State Building Code for additional information. 3. Stairway Headroom:Stairs between 1st 4 2nd firs,and 2nd 4 usable attics 3. Foundation walls shall extend at least 8' above finish grade.13402 .3 , 17 8, These drawings were prepared per guidelines set forth in the shall have a minimum headroom of 6' 8" measured vertical from stair nosing. 4. The bottom of an oint of a foundation shall be a minimum of 410" g P p P g Basement stairs shall have a minimum headroom of 6 b". below finish grade 13402 .3 ,4 ] Mass.State Building Code Section 134 1 for 1 4 2 family dwellings. 13401 . 10 . 8 , Fig.3401-14 816 . 2 . 2 1 6. Window pd dtazing shall be considered hazardous when used in doors, 8. The exterior surfaces of masonry foundations enclosing basements shall within 8'C of a doorway or closer than 18" to the floor. Windows used 4, Firesiopping shall be provided to cutoFF all concealeraft opening6 be dampproofed. 13402 . 6 1 " " (both vertical and horizontal) and form an effective fire barrier between for emergency egress shall have a minimum opening size of 20 x 2 4 9 y 9 P 9 A 1 ] , l columns act is determined b I Table 3408-6 . 34-16 1. �� 'p and the roofs ace 13403 . 2 6. Lal story P9 storms and between a top spacing y e a4 above the Finished p � p y In either direction and shall not be more than 1. Wall pockets: Ends or wood girders entering mason or concrete walls Floor. 13401 . 1 .2 4 3401 . 10 . 3 1 8. Insulation minimum total R value requieem..nts for p 9 n9 � with 1/2' it space on to sides and end,unless a rid 1. All walls next to sta6wa�}s shall have fire stopping (installed Exterior walls is 12B,Floor over unheated space 1s 20.0,Roof/cellir►g shall be provided a spa p, pp adjacent to and parallel with the stringers per C Fig. 3401 - 11 , assemblies is R30,and Finished basements walls is R12.8.I Table 3423-11 . durable or treated wood is used,13402 , 8 . 6 1 6, A vapor barrier of lA perm or less shall be installed on the winter warm 8, Studs in framed kneewalls shat! be 14" minimum in length and when the side of walls,ceilings and Floors enclosing a conditioned space I 3422 . 13 kneewall is greater than 4'0" In height, it shall be of the size required 1. When eave vents are Installed,adequate baffling shall be provided for an additional story. Kneewalls shall be thoroughly and effectively ALAN GENERAL NOTES" to deflect the incoming air above the surface of the Insulation with cross-braced.13402 .1 4 3402 .1 . 11 FLOG " R roof deck 3421 . 1 .3 7 . minimum of 1/2 in diameter, th.. C n anchor bolts shall be a min a 2 Inch minimum clearance under 9, Foundation 1. Smoke detector s stems shall be T e I•I I in conFormance with The shall have a minimum embed of 8 in poured concrete. 13401 .14 . 1 .11 .Detectors shall beplocated as follows: There shall be a minimum of two anchors r section of sill late. p P A minimum of one per floor and basement,one per each 1200 sq. ft. Maximum space shall be 8'0" on center,11104 . 8 ] or part thereof.One shall be located outside of each separate sleeping area and/or near the base of,but not within,each stairway. FRAMING GENERAL NOTES-- 13401 , 14 7 1 OTES-13401 . 14 , 21 1. All structural materials ahai?�be void of any defects tha-It may 2. Ventilation: Kitchens and bathrooms shall have mechanical venting diminish their capacity to function in an adequate manner. systems that provide 20 cfm/occupant,Bathrooms with a window which Structural Engineering or any other professional services that opens directly to outside air,no mechanical ventilation shall may be required shall be provided by others. be necessary I Table 3401-2 3401 .8 .2 . 1 ] . 2. Framing lumber. Spruce-Pine-Fir,No,2 or better, with a Design 3. Light and ventilation: All habitable rooms shall be provided with value in Bending 'Fb" of 1000 for normal duration. aggregate lazin area of not less thane ht (8) per cent of the I Table 3403-3D 1 glazing J floor area of such rooms. One-half (1/2) of the required area of glazing shall be openable. 3. Minimum bearing for joist shall bel 1/2 13408 . 2 . 4 ] 4. Ha11 and stairway widths shall be a minimum of 3 fest clear. 4. Use built-up 2 x 4 posts under all beams (4 minimum) . Handrails may project no more than 3 i/2" into the required width. b. Double up floor joist under partition walls above. 13401 . 10 .4 . 2 , 3401 . 10 . 8 1 S. Window rough opening sizes shown are For RIVCO Window units. i Continuous BafFled Ridge Vent Ridge Board V _ 2x Bottom Plate ^1 x 8 Collar Ties ,@ 41011 D.C. Roof RaFter 2x Band Joist ,� Floor Sheathing Roof iZafters -Q Maintain 2 ;.in, clearance 4 ' 2x Floor Joist ----- ----- Fascia Board Ceiling Joist Overhanging soffit 2 - 2x Top Plate ----- - with venting C Exterior Intern, Fir. „ _ , -- Ridge Detail �, : ,� Soffit I� etail l/2�� : l0 12 . 10itg112 10 PA 2x 5ottom Plate - 2 x 4 Bottom Plate ,. �x Bottom Mate 2x Fire Blocking 2x Band Joist Floor Sheathing R20 Insulation � 2x Floor Joist + R20 Insulation 2x Floor Joist 2x Floor Joist 3 - 2 x 12 Center Beam Lalli Column Gap Plate 1 - 2x6 P,7. 4 1 - 2x6 K.D. Sill 2 - 2 x 4 Top Plate rasten to Gent4r Beam 9 w/Sill Sealer .� D —3 112 Dia.Lall Column 1/2 Dia, x 1Z L . y � 9 Anchor Bolt �lr, „ , „ Genter Beam � „ , ,� - � 5 i 1 l Concrete FoundationfnternalInterm, 112 : l 0 1/2 : 1 o 112” I'o' Flashing WHOM i —2x Deck framing (P.T.) —Joist Hanger a Concrete f=oundation COLONIAL 5TANDARD DETAILS C� Stair/Deck Gonn, 11211 . 1'O11