HomeMy WebLinkAboutMiscellaneous - 53 CONCORD STREET 4/30/2018 53 CONCORD STREET
210/084.0-0011-0000.0
Date.
77bt,
NOR TIy
,e1'40
` TOWN OF NORTH ANDOVER
- PERMIT FOR GAS INSTALLATION
• ,' a
S'A USES
This certifies that . . . -, O . .L ". . . . . . . . ,v. . . . . . . . . .
has permission for gas installation
in the buildings of . . . . .17. . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . .�-�? 4� T . . . . ., North Andover, Mass.
Fee 3U.P�?. . Lic. No.. 1.�:: .Y 5 . . . . . P4L7Z.T tChr�.ti
GAS INSPECTOR
Check# ( �S
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
/1)0. "' ae'r Mass. Date 20_�[_Permit#
` Building Location 3 C�awco rY.( S _Owner's Name
Owner Tel# M—M _qQ d l Type of Occupancy
New ❑ Renovation ❑ ReplacementY Plan Submitted: Yes ❑ No ,
FIXTURES
LU w o U x
z a� H ¢F > Z z p F"
m w d d w 0 2 a 1)4w d w
C to z 0 A z
W L cn J z d
C7 z ! H F w c7 O w z a a
SUB-BSMT
BASEMENT
1 ST FLOOR
2"D FLOOR
3RD FLOOR
4TH FLOOR
5T"FLOOR
6T"FLOOR
71"FLOOR '+
8TH FLOOR 1 1+
;
Installing Company Name :3-0�� Le-0k,C CC/ Check one: Certificate
Address 6 v,C-k ❑ Corporation
awt.� + 4 N,)41 ❑ Partnership
Business Telephone# &D 3 300' 90,?/ ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter ` Vw1 p O y eA rC/
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142.
Yes ❑ No ❑
If you have checked y2s,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:
Signature of Owner or Owner's Agent Owner ❑ Agent El '
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 installations performed under the permit issued for this application will be in compliance with all
ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws
By Type of License:
•-Plumber ignature of sed Plumber or Gas Fitter
Title as fitter
oJ
aster Licen umber.
City/Town •-Journeyman
APPROVED(OFFICE USE ONLY)
Location �.[� C ��
No. � � Date � 75
^,yORTq TOWN OF NORTH ANDOVER
►°.3 .• 09 Certificate of Occupancy $ ..Y."
+ _ Building/Frame Permit Fee $ Z
f'7d''•a°'�c�' Foundation Permit Fee $
3ACHUSt
Other Permit Fee $ _
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ 107S,
wldinglnspector� 06�95 15:00 1.025.00 PRI
L✓�^: Div. Public Works
Lobation :� �' �O"i(C)"L�
No. Date 4�1 I�, (C(
�oRTM TOWN OF NORTH ANDOVER
L
p Certificate of Occupancy $
Building/Frame Permit Fee $
300 Foundation Permit Fee $ 00ACNUS
3
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
T Building Inspector
06AIW95,14.53 150.00 PAIn
Div. Public Works
Location = •> C/%t C�%fii S '
No. ; ' 1 Date J
NORTH TOWN OF NORTH ANDOVER
F Certificate of Occupancy $
Building/Frame Permit Fee $
''s E
cMus Foundation Permit Fee $
� s� t
s Other Permit Fee $
Sewer Connection Fee $
: Water Connection Fee $
TOTAL $
Build- In pe9tor
a C Div. P;bbl Works
.. .-0
PER3fIT NO. -n V APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
MAP KJO.' LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE
�? ZONE I SUB DIV. LOT NO.
a LOCATION 3 Y PURPOSE OF BUILDINGInk C2sir'c f7'�:
"OWNER'S NAME ^ ew, NO. OF STORIES SIZE
OWNER'S^ADDRESS " U `�� `l OAIV BASEMENT OR SLAB ✓.i n c mol-}-.
ARCHITECT'S NAME 'evav - e SIZE OF FLOOR TIMBERS IST apo \2ND ax IO 3RD o)Xiv
I UILDER'S NAME _ J, evw SPAN 1 y -- /.
DISTANCE TO NEAREST BUILDI G ✓� DIMENSIONS OFF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES—SIDES ^JU REAR "" GIRDERS I'll X/O 1
e AREA OF LOT �f1 ^�,� FRONTAGE HEIGHT OF FOUNDATION '7'/`r THICKNESS JO//
IS BUILDING NEW I \je5 SIZE OF FOOTING 4 /�/�v�� X
IS BUILDING ADDITION ly MATERIAL OF CHIMNEY / r�
IS BUILDING ALTERATION ✓V /� /� IS BUILDING ON SOLID OR FILLED LAND \ „r
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE G S IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY A f� IS BUILDING CONNECTED TO TOWN SEWER
/V IS BUILDING CONNECTED TO NATURAL GAS LINE(' e-s
INSTRUCTIONS 3 PROPERTY INFORMATION
PERMIT FOR FOUNDATION ONLY LAND COST yso o
SEE BOTH SIDES REGULATED BY PARA. 114.8-S. B.V. EST. BLDG. COST
PAGE 1 FILL OUT SECTIONS 1 3 EST. BLDG. COST PER SQ FT.
- 7 O
• PAGE 2 FILL OUT SECTIONS 1 - 12D TE / ��FEE PAID_ EST. BLDG. COST PER ROOM'
Y� fGG t`� SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING �7 4 APPROVED BY
•ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
V DATE F ED ci
V
/ -KA�" *) �uILaINo INSPECroR
SIGNA rURE O NER AUTHORIZED AGENT r j f� y
FEE FRAME/BUI" DING OWNER TEL.N -�v u y 7I(l�a
PERMIT GRANTED PERMIT FOR q
V J
CONTR.TEL.1l
19 DATE; FEE PAID CONTR.LIC.#
�. H.I.C.N
• :: �, 8 6�Z COKA� 2:)3Z
JUN 12 , . �� o S� -`� QIK * ZI x-n
0,3 7 9 - 111�e-
' n
BUILDING RECORD` '
1 OCCUPANCY 12
SINGLE FAMILY STFFICEORIES 1
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OS LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GSA-
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE d 1 2 13
CONCRETE BL'K. PINE
BRICK OR STONE FLA _
PIERS PLASTER -
_ DRY WALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'TAREA
'/, 1/2 FIN. ATTIC AREA
N_O B MT FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WAILS I 9 FLOORS
CLAPBOARDS 8 1 2 3
DROP SIDING CONCRETE
WOOD SHINGLES EARTH _
ASPHALT SIDING HARD1'J D
ASBESTOS SIDING _ COMMCN
VERT. SIDING ASPH. TILE ---{I_
STUCCO ON MASONRY �—
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STIRS. d FLOOR _ a
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING _
STONE ON FRAME
SUPERIOR I� POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE HIP BATH (3 FIX.(
GAMBREL MANSARD TOILET RM. 12 FIX.( _
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR 6 GRAVEL STALL SHOWER
ROLL ROOFING I MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE f
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM _
STEEL BMS. S COLS. _ HOT W'T'R OR VAPOR _
WOOD RAFTERS AIR CONDITIONING -+
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd ELECTRIC
1st 13rd NO HEATING
t
• 0t%ORT11Town of
' over270
F
No.
C% rt, dower, Mass. 19`lSLAKE '
O COCKIC EWICK ��• }
AOgATED AP4 �y
BOARD OF HEALTH
Food/Kitchen
Septic System
PERMIT T
BUILDING INSPECTOR
THIS CERTIFIES THAT amu!' \AS .k". . � .....................................
....................................................... ............. ................................................. Foundation
has permission toerect..0 ....f!t?AM�... buildings on..... ....... ...................•..••..••.••••• Rough
to be occupied as ...4 uP . .. l�J� . . � � ...... Chimney
provided that the person accepting this permit khall 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.PERIARI O of
Buildings In the Town of North Andover. PLUMBING INSPECTOR
- REGULATED BY PARA. 114.8-S. B.C. ,
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
UE At FEE PAID Final
PERMIT EXP1 MON-1-H6UTOAT ELECTRICAL INSPECTOR
UNLESS CONS 1 - Rough
...... .. ...... . . ........... Service G`
BUILDING IN ECTOR `,��,�
Final v
Occupancy Permit Required to Occupy Buildingu XA F GAS rtraoff
Qti he
Display in a Conspicuous Place on the Premises — Do Not Remove al
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT
Burner
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
AZ-IG —
..+M[....-. .a .. .- .. , _-- ._. '- -..w.-_ -w -_-cT_ti-,.i-Cs....Y^-..�_.- . -"n _-_i i s ...__ , _ ` ' •
-
_.FORli U — ZDT RELEASE FORK -
INSTRUCTIONS This fora 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 statelaw,
regulations or regu re�rts. _. -
fills out .this section*****************
APPLICANT: �.C�VJ ��� ��, ►IC"VfN p1,v^e .`�u 7i`6�n)
LOCATION: Assessor's :dap Nuke_ Parcel
Subdivision Lots)
Street '
St. Number 5-5
6v-
xiet* t* tirkticir* t ty'ttieEiieier+':�C' 3� .'Se Qnl T** EyiieEirkxeirie:Eirieic�ritiiei*ie
RECOMIKF_ IONS OF W'N AGS-SITS:
%�' Data Approved
Ccmmerts
Oa approved
_cwn ?-anne_ Data Rejected
vv
=enzs
Date Approved
ced Date Rej ected
Date Approved
yap sic Inspector- e=-_-- Data Rejected
C ort-:e n c s
-to ree-
. � V
Public Works - sewer/water connections
- driveway pe^it
De•5 ne•.}
Received by ui-d_.ig Jrs=ecm=rDate
j
e Commonwealth ofMassachusetts
- ( epartment of Industria[Accidents
— ®!1!6001/ o"OOS
_ 600 Washington Street
Boston,Mass. 02111
V / Workers' ompensation Insurance Affidavit
location:
S �c1.vCav S
1 0 dye phone#
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
n I am an employer providing workers' compensation for my employees working on this job.
:Company:name:
address-
CRY:: phone#
insurance co. policy#
„0- .:
I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers'^compensation polices:]
comnanvname. aiP frC'[7 C-,
address: �� 13U1�
city. Ulla✓ phone#• t
insurance co.
policy# ,
f.
company name. -
address,
CRY: phone#-
insurance to, poli y#
na ee neeessa
Failure to secure coverage as required under Section 25A of 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 5100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification.
I do hereby certi u er th aims and penalties of perjury that the information provided above is true and correct
Signature Date IKA .l,
Print name Phone#
official use only do not write in this area to be completed by city or town official
city or town: permit/license# OBuilding Department
[]Licensing Board
0 check if immediate response is required []Selectmen's Office
[]Health Department
contact person: phone#; nOther
(revised 3/95 P1A)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", 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 section 25 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, neither the commonwealth nor any of its political subdivisions shall enter into anv 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.
�r
.ii /ry
Applicants
Please fill in the workers' compensation affidavit completely. by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits 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.
i 4 p
City or Towns
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. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
.y,:.,�,:.
f', .F .. •tt. >,.u. ty ,�,,.' `Y,' ti`c�z' •ra �` _ _ '`a".5.:..2 r;oa�,.- ,1'mxl,r,:a tiY",,� ...
The Department's address, telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
office of lovestigetiens
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 7274900 ext. 406, 409 or 375
ek .. — :tip' 1,:3 ni"
COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY
'. =auu�®4opOs%dss 9cGl3.:
E �Iassachdsatts5'tateBdiidr'••
OF : ONE ASHBORTON PLACE - J, I -,*dsiscause for:awc-cfuJc--
V MASSACHUSETTS i 8GSTON;MA 02-1
�i yAls liaaAas.
L -E N' •* CAUTION
EXPIRATION DATE C i'+ '_TR I UP =A V I S K I,
09/21/1 EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST
RESTRICTIONS THEFT, PUT RIGHT THUMB
n.4 E 3�/ q 3 j 1St,) PRINT IN APPROPRIATE
BOX ON LICENSE.
):J•;i- iS J AHcc21i
- BLASTING OPERATORS
SS 015-4E-564) � Tc 4.<;, ;JRY '1A 01976 MUST INCLUDE PHOTO.
PHOTO(BLASTING OPR ONLY) FE C_j
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ! I�^
HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER
DOB: U L 0 2 1993
053 :
THIS DOCUMENT MUST BE « SIGN NAME ICFFFiE6 ABOVE SIGNhiURE LINE
THE HOLD THEWHEN PERSON OF =�w JOSATURE OF LI NSEE
THE HOLDER WHEN EN- L
OTHERS-RIGHT THUMB PRINT GAGEDIN THISOCCUPAT10N. I OM#--LONER J
JUN 12
• !�t/A Y',c/� ; Tie C;--
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AV 7.yE BAAW 7,047'T.yE OwEtL/.t4t/S LPc'ATEO O.v
Me cor.ls S.se�/r.V AND T.SG4T?OG+Es GO.�/FAPO/ //(/
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iQL�6rI.00/.tom' JET�.IC.t'S FEOiIf ST�EC'TS�GOT L/.vES.'' /VO. �N04vE�2/ �AS,s
S F!/.�7'HC.0 CE.�T/FY T•V.IT T•f�/.s OwEGC/�Y6 /S�t/OT
LOG4TEo/�/ T.f�E FEpE.P.4G FCaoo AX04.4-0 APER. O�P.9�✓/V FOP
SryawN OiV FfM�1'COM.y�N/Ty P.I.VGL '�
2sOo98 0003C-
OF
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x:36381
Ale, .P/rtl.4Gf'E'.f/G.WEE.P/•l�6 SE.PI�/GES
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�•2't-C�
CERTIFICATE OF USE & OCCUPANCY
• Town of North Andover
Building Permit Number CIS- Z10 Date UPI I I_STV
THIS CERTIFIES THAT
THE BUILDING LOCATED ON
MAY BE OCCUPIED AS f-AM1u..1 "DUPLEX_ IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO A►afa4q�1`E
ADDR P, $OZ f�A
s,cM„°c� ding Inspec or
i
f
r
NpRT
own of � � � rgAiridover
No. `4•'r
270
* t;
bo ort, dower, Mass., a�rtM_ (C 191-V
COC Hi ME WICK '
n V
AERATED
E BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System��'��fsi / t vJ
.� BUILDING INSPECTOR
THIS CERTIFIES THATV�IAS
.................................................... ........................................................................................
Foundat o
has permission to erect..U ,?n....Pl?14 .. buildings on �Sr
.....`...3............Tt.4.c ...... ..................................
to be occupied as.... ..PPL* ....TP0.1N.k . ...'OM .................."..:.:::.......................................................
provided that the person accepting this permit all In every respect conform to the terms of the application on file In Find
this office, and to the provisions of the Codes and By-Laws relating to the Inspection. A1tec t' d�nnstr,, tIn of
Buildings In the Town of North Andover. PMIT F�R �`^�'TArI[1N�NL�
REGULATED BY PARA. 114.8-S. B.C. PLUMBING INSPECT
a.
VIOLATION of the Zoning or Building Regulations Voids this Permit. 91'J�7 %�r'
c c_ FEE PAID
PERMIT EXP IR 6 MO ELECTRI AL INSPEC
UNLESS CONS T ou
PERMIT FOR FRAMUBUILD
ING /
...... . Service
BUILDING IN ECTOR
DATE: FEE PAID n Fi: e�7 q
Occupancy Permit Required to Occupy Building GAS INSPECTOR f
Display in a Conspicuous Place on the Premises — Do Not Remove Rough ,
r Dr Wall To Be Done `
No Lathing o y rtk
F E DEPAR ENT f
Until Inspected and Approved by the Building Inspectf J )
�} Burner �, z ',�� Street No�PLANNING IIV L CONSERVATION * FINAL
Smoke Det. J,
SEWER/WATER yyj(� FINAL DRIVEWAY ENTRY PERMIT9.�
�✓
Office Use Only U
u4P (Ifum ianwr# of �FIBBttL�j1IBP##B Permit No. (J
3 = +9evartment of Public 26afetg Occupancy& Fee Checked n
3190 (leave blank) + (�
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date --Iy' �S
(X* or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) /l lei)
Owner or Tenant T
Owner's Address
a D vrA
Is this permit in conjunction with a buil ing permit: Yes No ❑ (Check Appropriate Box)
Purpose of Building ()�'�'C XUtility Authorization No. -�� �F/
Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters
New Service d d Ampsl,1_6_J-L_01oIts Overhead Undgrnd ❑ No. of Meters
/ Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work ��� Xy.S ��
)/� v Total
"1 No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA
o. of Lighting Fixtures (j Swimming Pool Abovergrnd. Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets ' No. of Oil Burners I Battery Units
No. of Gas Burners FIRE ALARMS No. of Zones
No. of Switch Outlets
tb Total �— No. of Detection and
[ No. of Ranges I No. of Air Cond. tons Initiating Devices
No. of Disposals No.of Heat Total Total No. of Sounding Devices
P Pumps Tons --Kvit g
No. of Self Contained
No. of Dishwashers I Space/Area Heating KW-__ Detection/Sounding Devices
Local Municipal ❑Other
No. of Dryers I Heating Devices
KW' Local Connection 1
o. of No. of Low Voltage
No. of Water Heaters Signs Ballasts Wiring
No. Hydro Massage Tub No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws _
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES = NO I
have submitted valid proof of same to the Office. YES = NO If you have checked YES, please indicate the type of coverage by
checking the a opriate box.
INSURANCE BOND 7 OTHER _7 (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work S
' 3 9• Inspection Date Requested: Rough W Final
Work to Start
Signed under the Pen it s of p rp.
FIRM NAME KLIC. NO.
Licensee
O /V Signature LIC. NO.
�� Bus. Tel. No.
Address A C //T�T 11 Alt. Tel. No. rt
OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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 waives this requirement. OwAgent
(Please check one) qP V�
Telephone No. PERMIT FEE S
(Signature of Owner or Agent) x-6565
�� fav
Date..................... i...,....
,4ORTH
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
�,SSACMUSft
I
Thiscertifies that .........................................:..,..................................................
has permission to perform ......:.:. .:...........................,.................:.......I..........
wiring in the building of.............................. ....... ......................I...................
a
at..................................................:............................ .North Andover,Mass.
Fee...... Lic.No. .,...::../.
..............................................................
1/ ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File
J Date...:............
NORTH
TOWN OF NORTH ANDOVER
o ' PERMIT FOR WIRING
�,SSACHUS� _
This certifies that ...............................
has permission to perform ................................................
wiring in the building of....:, ,:.:..................................................................
at............................................................................... ,North Andover,Mass.
Fee.....-�............ Lic.No.............. ........................................I.......................
ELECTRICAL INSPECTOR
Check #
Official Use Only
Permit No.
Occupancy&Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date 5--12- Z/6 2_
To the Inspector o Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number J J Con 6o— C
Owner or Tenant 7 u S
cp
Owner's Address
Is this permit in conjunction with a building permit Yes V- No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters
New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work___—At t/( t ),/p C&q
Total
No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA
Above ❑ In ❑
No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA
No.of Emergency Lighting
No.of Receptacles Outlets No.of Oil Burners Battery Units
No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone
Total No.of Detection and
No.of Ranges No of Air Cond Tons Initiating Devices
Heat Total Total
i No.of Di sal No. Pumps Tons KW No.of Sounding Devices
No./of Self Contained
4 No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices
❑ Municipal ❑ Other
a No.of Dryers Heating Devices KW Local Connection
No.of No.of Low Voltage
No.of Water Heaters KW Signs Bailases Wiring
No.Hydro Massage Tuds No.of Motors Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO =
have submitted valid proof of same to the Office YES= NO = If you have the ked YE§please indicate thetype of coverage by checking the appropriate box
INSURANCE = BOND = OTHER =. (Please Specify) I--q / //f 3
t (Expiration Date)
Estimated Value of Electrical Work$ 10
Work to Start Inspection Date Resq sted Rough Final
t Signed under the Penalties of perjury: LIC.NO.
/\C�UI� ��.5 ��� � °
FIRM NAME /�. �n ( '/
Licensee 1r, ( 5��'Z 1:2� Signature NO.
uBs.Tel No.
28� 23-3—oY2
/
Address �V!/ Su Alt Tel.No.
OWNER'S INSURANCE WAIVER: I am aware that the enses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMITTEE $
V �
(Signature of Owner or Agent)
Location
53 CvA-)Cc CY S
No. 5 `� Date
NORTq TOWN OF NORTH ANDOVER
f �,Y
f? • • OR
9
Certificate of Occupancy $
•;°sem .• • —,._
CMUs<� Building/Frame Permit Fee $
` Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
�M
�
51 Fj !� Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
T
T'lii5 S> Qa ft► I
BUILDING PERMIT NUMBER: Ly
DATE ISSUED: rn
SIGNATURE:
Building Commissioner/12ERector of Buildings Date Z
SECTION 1-SITE INFORMATION o
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
S C-Ody co,-,- ?2 S' f e9 e9a / 1
Ae Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: �n
J
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D
Public 0 Private ❑` Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 J
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M
2.1 Owner of Record
PA-,,�,-L- T-v s A 5-3 CV/V C-41>z/J 5C— 4-u 064M 4
Name(Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
z�qq
M
Signature Telephone 90
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
3v( „/f/3��Y ��_ ���Z� 2 `�� License Number
Add ss /, (90 g
776?— moi'/�;— Expiration Date ic
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
"IV4,L--
Company Name
n ��`� p �, L Registration Number r
Addressg� �p �
70- f� l/ Expiration Date A
Signature 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 buildng permit.
Signed affidavit Attached Yes.......Pr No.......❑
SECTION 5 Description of Proposed Work(check all applicable)
New Construction ❑ Existing Building V Repair(s) ❑ Alterations(s) ❑Tddition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify V1 A
Brief Description of Proposed Work:
V1
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building (a) Building Permit Fee
G�O
Multiplier
2 Electrical (b) Estimated Total Cost of
f s Construction
3 Plumbing Building Permit fee(z)X (b)
4 Mechanical HVAC O
5 Fire Protection
6 Total 1+2+3+4+5 Check Number &74t-L lir
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, V/J- L T Z'A as Owner/ thorize ge of subjc�
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Pri t e
-- S-1G- Q2
Si natur of O /A est Date
v
ti!11
NO. OF STORIES SIZE
BASEMENT OR SLAB ND RD
SI/,L OF FLOOR TIMBERS 1 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DiMENSIONS OF GIRDERS
HEIGI IT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BLJJLDING ON SOLID OR FILLED LAND
IS 13UILDING CONNECTED TO NATURAL GAS LINE
✓fie 't0anvnxaiuuea�/ a�✓�aaoac,lu�aetta
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
I Number: CS 008828
4
i Birthdate: 04/20/1951
Expires: 04/2012004 Tr.no: 20132
Restricted: 00
VALJ LANZA
34 BIXBY ST
REVERE, MA 02151 Administrator
�\ ' ✓JZ�' �V/ O�!I?/JILIYI'LL!-lG'lX,(�!L C�f✓!i(.11�JclCZGIZGG:1(�J
i:I I'.. ! :i f'?C)i 1 0I c'. f' I ?fi I
•''�;.�;`;��r L'a;:�'.;I-.i>rl NI.I: .. ..i, I;II ., I I . . :, Ii?r•.
li�?tll<-,. I.Illl'�1 �:?vti1111i.111 t gill' } �., I �; I•:<�<.Il :r:l.iril i �: •li
0l i 0
I )''I 't`. Py .I �% I 1 t,: ?1 f'' I'I 'I I' 1 i;11
I; �r IIUIII I III'RUVI Iii N f C(1N f RRC I Ok
Al'it loll07/02/2002
I.)I1
ISIEW r_rlGl_.i1i\IL? C-u::; rOl°1 . _.
V I. L.-<:t n z .I c type: Private Corporal o
r ,
W7:.L..P'IXNGT0N IIA 01.t:ii. NEW ENG(OS:U UJSlOf1 DESIfik,
Val Lanza
LHELL Si.
ADMINISTi1AT012 l�1111 I N G I 0 W
tlR 01137
I
u
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office or'lnvestigations
Boston, Mass. 02111
Workers'Compensatlon Insurance Affidavit
1 Please Print
Will iN
Name:
Location: (_D 1�Ca>l./) -7-
Ci
C{ty A/ Phones �J'7�^ r'i�� • ��3_
am a homeowner performing all work myself.
01 am a sole proprietor and have no one working in any capacity
F-Vrf am an employer providing workers'compensation for my employees working on this job.
GompaMf name: S,/6-
Address
Address 7 7 G �(✓h-fliLrf 1'
City:_Vl/i Phone*. l 70-cz,
CQmr.M name:
Address
City. . Phone#-
s rai ,Go. o
failure to secure coverage as required under Section 26A or NlGt_1,52 can leaf!to the Woman d criminal penalties of a_fine up to$1,500.00
and/or one years'imprisonment as welt as civil penalties in the faun of a STOP V40RK OPMM 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 d the DA for coverage verification.
I do herby certify u er the ai*nsjlw les of perfury Ural the fnformathw provided above is roue ani!caret[
Signature ' / Date
Print name V/� Phone
Official use only do not write in this area to be completed by city or town offiaar E] Buildingp
De t
OCheck iPimmedfate response it requked Building Dept D Licensing Board
El Selectman's Office
Contact parson: Phone## Q Wealth Department
Q Ofher
?:5t WORKMAN S C0h9FENSATI01u
ToVM Of over
0
No. tQT77 1�_
Ake
LA o dover, Mass.,
COCMICMEWICK V
ADRATE D P'17 ,�5
S H BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
Paw l � V �� BUILDING INSPECTOR
THISCERTIFIES THAT...........................................................�.................................................................................................. Foundation
has permission to erect .............. buildin s on N t yr
p g ..... .............................................................. Rough
to be occupied as..... ......r. . ... �I .. �.. .. ....................................................................... Chimney
provided that the person acceptingis permit shall in every respect onform 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. a y/t f 9 /tv PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION T S ELECTRICAL INSPECTOR
C � 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 DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
y
SEE REVERSE SIDE Smoke Det.
Location 5
No. Date r
TOWN OF NORTH ANDOVER g
3? e • pL M
` p Certificate of Occupancy $
> _ Building/Frame Permit Fee $
� r
• i �
,SSACMUst� Foundation Permit Fee $ -'
Other Permit Feke1,�O $ 'SU
�� L
Sewer Connection Fee $ N
Water Connection Fee $
TOTAL �, $ 3,C 1
}
Building Inspector
c- Div. Public Works
PEWMIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1
MAP KdO. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK PAGE
ZONE SUB DIV. LOT NO. �—I ;
LOCATION Q od Sri PURPOSE OF BUILDING (M I� f �
OWNER'S NAME r NO. OF STORIES I ,• SIZE/, ,Y
J
CSWNER'S ADDRESS
K BASEMENT OR SLAB
ARCHITECT'S NAME , SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME ' SPAN
DISTANCE TO NEAREST BUILDING l o o DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
[�b
DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES
EST. BLDG. COST
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
+ � 9UILDINO INSPECTOR
SIGNATURE OF OWNER I D OR AUTHORAG NT
F E E OWNER TEL.#
PERMIT GRANTED CONTR.TEL.#
�19
CONTR.LIC.#
H.I.C.#
BUILDING RECORD
1 OCCUPANCY 12 "
SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 0 1 2 13
CONCRETE BL K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER
_ DRY WALL
UNFIN.
3 BASEMENT 11
AREA FULL FIN. B M'TAREA _
'J, 1/7 '/, FIN. ATTIC AREA _
NO BMT FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDW D _
ASBESTOS SIDING _ COMMCN
VERT. SIDING ASPH.TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MA N Y ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I-A POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE 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 I 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. G COLS. STEAM
STEEL BMS. 6 COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GASOI L
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
NORThq
Town
of 4Andover
0L
No. 219
-s
yr dower, Mass., A�- ZS 19 ,5
COCHICHEWICK �
"iA ADRATED p`Pa\ ��
1 BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
A L r A BUILDING INSPECTOR
THIS CERTIFIES THAT�.06LAS..... 4a.94 ............................................. Foundation
has permission to efee3SK��g,
.......... .
to be awnpWss....�tAQ.....IaKwl...... � -�.... `!�V�l�,.,��.... ��.n Chimney
provided that the person accepting this permit shall in every respect conform�dthe terms of the lication on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS COSTRU N
ELECTRICAL INSPECTOR
T
Rough
. ... ...... ......... Service
BUILDI SPECTOR Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT
Burner
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
. 31
d Mo.rti
KAREN H.P.NELSON dr' Town of 120 Main Street, 01845
Director
NORTH ANDOVER (508) 682-6483
BUILDING s :..,✓44°
CONSERVATION °'�'"°' DIVISION OFHEALTH
a
PLANNING PLANNING & COMMUNITY DEVELOPMENT
DEMOLITION OF BUILDING AFFIDAVIT
DATE
OWNER'S NAME & ADDRESS lJ4kefrO f d r
LOCATION OF PROPERTY TO DEMOLISH
DESCRIPTION Q G d
CONTRACTOR'S NAME & ADDRESSJAII �lw Cn_
DEPARTMENT SIGN-OFFS
DEPT. OF PUBLIC WORKS - WATER: �� SEWER:
GASf eG l e 17�G 2
ELECTRIC
G ll
TELEPHONE 3� /U b I C C
CABLE SC��►�► 0GA _ tete .
TAXES
POLICE
FIRE G- "�: l�r ( ` ['f 5.F2�u c 4*f c/O/V-6
EXTERMINATOR
DUMPSTER - ON/OFF STREET 6 e -1/v o ' e
DIG SAFE NUMBER Cis 00 11310 _
DATE RECD BLDG. INSPECTOR
,f 16-95 'i""E 15,07 F,) STAFF G`: S
a •
- r
r• ,
1
1