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HomeMy WebLinkAboutMiscellaneous - 548 SOUTH BRADFORD STREET 4/30/2018 548 SO BRADFORD STREET J 210/104.C-0159-0000.0 Date....��Iq ../..3 ....................... t pORY TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION r -- T' e 8`4ACHUg� w This certifies thatrl........k;AAr:.0..S.........................:............... .......................... �as permission for gas installation ;!.... ...� _.the buildings of.,. ' F � ... .-, ' Cf ';�j l ....5..:....!J. ..�,' ................... North An over,Mass. F� %t....cad....... Lip. NOA/�`fes ............................... a ... .... .. ..:...9�.. GAS PECI�R Check# 8 ' 1 4 i E . Nj � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY rr _ �.✓�� e� __ —. MA DATE o , PERMIT# 1 JOBSITE ADDRESS _ OWNER'S NAME e4 GOWNER ADDRESS _ _ TE _ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:E] RENOVATION:0 REPLACEMENT:® PLANS SUBMITTED: YES No E] APPLIANCES 7 FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER E. _ 1 „-.1 - I BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER 1 _ �! FIREPLACES FRYOLATOR _ 1 FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT J TEST UNIT HEATER '-- UNVENTED ROOM HEATER WATER HEATER 'THER I r , INSURANCE COVERAGE /,lave a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES jErNO [�_E I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND EI OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER- ASFITTER NAME Slra/ ,l.,JAtS�.� - _ LICENSE# 1��6 � ./ ` ( SIGNATURE MP . MGF[jI JP JGF�_( LPGI CORPORATION D#�PARTNERSHIP®#�� LLC 13#L -11 COMPANY NAME: _ ADDRESS CITY n^ e i'l .i�, ,_.. _._ _ I STATE _ !o ZIP O 15y� TELFAX �CELL 7ti by _v .. 6 EMAIL tLUZ5,cE (e ICA LJ i ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No s. 161hz k? THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 3 The Commonwealth ofMassachusetts - Department oflndustriaMccWnts Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/ilia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 1" ArS,), 3 1 L 6 & (ft—(, Address: City/State/Zip: ^ ey F1..�^, nl%� Phone#: 4- ;Fa 1 l G � 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 loyees(full and/or part-time),* have hired the sub-contractors 2.al am a sole proprietor or partner- listed on the attached sheet.x 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their �,� ' 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.L�dumbing repairs or additions myself [No workers' comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13-ElOther comp.insurance required *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they Rite doing all work and then hire outside contractors must submit anew affidavit indicating such. TContractors that check this boxmust attached an additional sheet showing the name ofthe 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 andjob site information. Insurance Company Name:. Policy#or Self-ins.Lie.#: Expiration Date: VJ7`i Job Site Address: 4 s CT-- City/State/Zip:�vr 7 u ftp 0 Ver— Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or oneyear 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 DTA for insurance coverage verification. Ido hereby certlo under//the pains andpenaldes ofperjury that the information provided above is true anti correct. Signature: .�d� Date: 13 �� 13 Phone 4: gi 7T tea-1164 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Fermit/License# ' Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - `1 P lnfor�naflon 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 ofhire,• express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confnmation ofinsurance coverage, Also be sure to sign and date the affidavit. The affidavit should be,returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' . compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials -P-lease be sure that-the affidavit is-coin lete-and rintecl le ilii : The De artmerit7�as rovideil a s ace at the botEom p p g Y l? P p of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a tali. The Department's address,telephone and fax number: Tho Gommonma of iassa�hUsPtts DopazGx 'Ont offadustrlal,A,elbats Office offavestigatiom 600Washington Stre-t Boston?MA 02111 ` ol,#617-727,4900 at 406 or 1-877,MASS.ABF Revised 5-26-05 BaY,#617-727-7749 Location _Sd�i l7YGLrf7Y �� �ar Z No. ? Date -7" x'95 W f NORTH 1 TOWN OF NORTH ANDOVER p Certificate of Occupancy $ " Building/Frame Permit Fee $ ' ',•°` t�' AFoundation Permit Fee $ �► •°rCM%15E i Other Permit Fee $ j Sewer Connection Fee $ $ / Water Connection Fee $ S TOTAL $ Zb T). 4-b (ID, 1 i Ins ' 3 l 33. 14:59 1,077. ""_P41 p r _ . 8p g 9 O 9 Div. P c Works L r 44ocation SAP� a 1.1OA1)frM 0. Date �(, NORT„ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ;��'�• <� Foundation Permit Fee $ 1w s�CHuse } Other Permit Fee $ II Sewer Connection Fee $ C' Water Connection Fee $ TOTAL $ G1� 150.04 PAID Building Inspector � ?• .8615 Div. Public Works i PER-111T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. � PAGE 1 MAP 4-40. /d 4/ LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK iPAGE ZONE■ 17 I SUB DIV. LOT NO. � 7 a8- 5; LOCATION S- 2 ,_�J �q� ��— PURPOSE OF BUILDING 'OWNER'S NAME NO. OF STORIES �J SIZE • OWNER'S ADDRESSJO L' �1m �/' BASEMENT OR SLABQ,+{CJ�IQ ARCHITECT'S NAME p '. Alp C SIZE OF FLOOR TIMBERS DIST !'1/`to 2ND �JY�� 3RD a�L� I BUILDER'S NAME ��)�,L SPAN /y dPC- DISTANCE TO NEAREST BUILDING / DIMENSIONS OF SILLS •DISTANCE FROM STREET (0D " POSTS t/ ire DISTANCE FROM LOT LINES-SIDES 3o REAR Gam- GIRDERS ;e x/ •7 AREA OF LOT 3o o.>-f FRONTAGE HEIGHT OF FOUNDATION/ ` THICKNESS /6 g IS BUILDING NEW SIZE OF FOOTING X /0 ti (� IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON LID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER es BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER Y --- 3 IS BUILDING CONNECTED TO NATURAL GAS LINE p 5 INSTRUCTIONS 3 PROPERTY INFORMATION PERMIT FOR FOUNDATION ONLY LAND COST / D 6 va SEE BOTH SIDES REGULATED BY PARA. 114.8-S. B.C. _ 3.a3,-7j EST. BLDG. COST EST. BLDG. COST PER SQ. FT. / PAGE 1 FILL OUT SECTIONS 1 - 3 (1°Q PAGE S FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM DATE FEE PAID SEPTIC PERMIT NO. ELEC=TRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY _1 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED :rJ BUTMING INOPSCTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT If PERMIT FOR FRAME/B1lit 1111►i FEE ��� -' OWNER TEL.# - sr� - tea Z� PERMIT GRANTED DATE:.._.�fEE PAID:........... CONTR.TEL.# ��- ll� 19��� CONTR.LIC.# 6,T'Z 2 H.I.C.# M JUL �� � " L� — 8�jo3 1995 3 3s�3 a�- Y , BUILD" RECORD O� # 1 OCCL PA'V Y ` 12 V, SINGLE FAMILY OR,IES IS SECTION MUSTSHOW EX�4CT MEN510f�(5�Q F OT AND DISTANCE FROM MULTI. FAMILY Q)=F,1 ___..,.LOT LINES AND EXACT DIMEAtSJC I S OF 'tJ'�Y�.E11NGi0-WIT-W-POR6HES, GA- APARTMENTS -- RAGES, ETC. SUPER IMP95E�Q�,._ WERL�AlaES'L14T�P!q. CONST UCTION 2 FOUNDATION $ INTERIOR FINISH •--�-.� CONCRETE d I 2 I3 CONCRETE BL'K. PINE Y + BRICK OR STONE HARDW D ` PIERS PLASTER \\ O C� DRY LL NFI U 3 BASEMEttS"-., I c AREA FULL IN. BM'T' A _ '/ '/r �/, FI . ATTIC ARE N_O B M T FIRE PLACE-- 1 _ HEAD ROOM _ MODERN KITCHEN 4 WALLS FLOORS CLAPBOARDS B 1 2 3 DROP SIDING C(ACRETE WOOD SHINGLES r EARTH ASPHALT SIDING HARDVV'D _ ASBESTOS SIDING COMMON _ VERT. SIDING ASPH.TILE _ STUCCO ON MASO RYA-` C ,Nit STUCCO ON FPAME _ \ _ BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAM CONC. OR CI 7DER-BLK. STONE ON MASONRY WIRING STONE ON FRAME :. 'L u SUPERIOR POOR ADEQUATE I--i NONE 5 ROOF 10 PLUMBING x GABLE I HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE PLUMBING ST TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR k .\ TILE DADO + - e`q r. ` - tr.^• i FRAMING I 11 HEATING IPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM 1 STEEL BkS\7k C S. _ HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS j ppse� ELECTRIC IL ++► lZAliiinl � B'M'T 2nd � � E1st 13rd I O HEATING i FORM U - TAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** XDPLICANT: /f V '. Phone -A 3 1, da CvM4 11-Z LOCATION: Assessor's Map Number / J6 Parcel Subdivision 9. jel`sli or S (s) 40;z- Lot SAO u �� �7Io[�I�+�cY St. Numbers ************************Official Use Only************************ RECO NDIIA- AT ON , .OFOWN GENTS: / Date Approved Con ervation Administratorff Date Rejected Comments �eCOM�S GA-5t� y I`tkki WbVk aS Sin-��► OAJ Date Approved Town Planner Date Rejected Comments _ Date Approved Food Inss�pector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections 7-2-4--�5 - driveway permit ��W 7- 24 --75 Fire Department �Received, by .Building Inspector Date f t JUL Q 1995 NORT ONM Of � � � - 4Andover No 367 i ort dower, Mass. U1985" T O �- LAKE COCIiICkiEWICK ADRATED P'? ,�� .1 E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR ;• THIS CERTIFIES THAT�-��.lA�l....�l�.t..�tE�..���P�1�?.�.•••• � :.................. oundatio Lb k- W buildings on ..548. . ...... .1....••.• Rough has permission to erect......�'!Q..�lY1i�.•... •••••••••• �•••• ••�••••••••••• to be occupied as 2.%1A6 *.,,. 11W . ...� . x...... 3...U( . Chimney provided that the person accepting this pdrmit shall In every re pact conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the zoning or Building Regulations Voids this Permit. REGULATED BY PARA: 114.8-S. B.C. Rough Final �� FEE PAID PERMIT EXP - ELECTRICAL INSPECTOR F CON U S Rough E . . G ... Service .. . . ..., . . . . . .. .. .. . .. BUILDING INSPECTOR Final . `," G`Lt P11it 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 PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER WATER FINAL DRIVEWAY ENTRY PERMIT � Date. ...55..: �. ��.�... ♦ ,�Op TH oTO ZOFNORITH ANDOVER ,dn - PERMIT FOR GAS INSTALLATION SACHUSEtt This certifies that . . . +' -. . . ^ -''. . . has permission for gas installation_.. in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at '� "�' 1. . - ... . . . . . . . . .. ° North Andover, Mass. o� Fee;-;t7 Lic. No..c�/.2I!. . . . . . . . . . . . . �� GAS IPi�S,PECTOR Check# ell- 633.2 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations �� .S o A 1)t'ot 0 37— / Permit# 6�3 � y Owner's Name Amount$ C,-20cw New D Renovation Replacement to Plans Submitted 1 � a CA w w c i O z F { 4 V U W x Z FFa n+ a d w w d x o4 C w C w G F x z W C7 O > rs U v� 4 z F w w a z w a F m z o i w o x x o x 3 0 .da o z > o a F O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) �� Check one: Certificate Installing Company Name A LL w oR a (, Corp. Address Pa t30,' 5- -7-2- L I W/1 etiCe hi 4 o!y yc ElPartner. lob' gS�� Business Telephone Firm/Co. Name of Licensed Plumber'or Gas Fitter /oJ i INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes No If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity D Bond 13 Owner's Insurance Waiver: I,am aware that the licensee does nhave not hthe 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 13 Agent 1 hereby certify that all of the details and information 1 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas pCode and Chapter 142 of the General Laws. sS '/OttBy: Signature Signature of Licensed Plumber Or Gas Fitter Title ® Plumber 12 Y 8�3 City/Town, Gas Fitter License Number Master _ APPROVED(OFFICE USE ONLY) ® Joumeyman "ORT" TOWN OF NORTH A DOVER PERMIT FOR PifJMBING ;,SSACMUS� This certifies that ., _.P.�' ,w- ., :!. . . . . . . . . . . . . . . . . . . has permission to perform, _._ ?�!�.- %u, *�--. -��• • �-.�• '• plumbing in the buildings of .l_. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... ., North Andover, Mass. Fewer. . .Lic. No .3. ` !t. ,r. . . . . . . . . . . . . . PLUMBING INSPECTOR Check y 9 7657 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location S, q-A 0 1 okG STOwners Name yA.-b) ��i�'i('y permit Amount � 7� Type of Occupancy &Iellck.15' NewRenovation Replacement rM Plans Submitted Yes No FIXTURES H H w w v rn * z a O W A a w y x a z a w U x .�.a 4 A A a ri C0 't 7 A a SL�g4VVIC ]S�)HT�OCl2 � 2N.1�I�OI2 3M)H jDaZ f 4M H—OCIR smHfm 6M HjOCIR < 7M ILOC Z 9M H!C (Print or type) Check one: Certificate Installing Company Name jozv n 8rN ❑ Corp. Address 10,9- edX .57-L C��`C Partner. /)7,4. ,4. 0/,jt Y A- � usiness Telephone 4P jf S=9 ®© Firm/Co. Name of Licensed Plumber: 7Z5,01 AW IIaIIA,-� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumb' Code and Chapter 142 of the General Laws. By: rgna ure or Lrcensea Plum er Type of Plumbing License Title � 33 City/Town rcense um er Master ❑ Journeyman My APPROVED(OFFICE USE ONLY 2c;) _ v yz �yr i -�� —� % �� \ �Qf7se:` .GO ����..�� i I RAP .� .3 < LOT \ Y 00 1-1 Alt sp ru 1> • -yu \ FNp E � \. DhAlt, JiA: r:ffset: 91 .DR /N STA: •15 sM G4S Of�et: 15.50 R DRA/h STA: •0�77•�5 \ . • i 1 —Offset: 15.50 � EX/ST/IvG EXIST CUL DE SAC SEWER STA.0+0� -PA VELDT TO & RIM=190.61' RIFM INV.=185.61' Y�,y_ CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number_ Date THIS CERTIFIES THAT THE BUILDING LOCATED ON 5 �� ZR A Q F d R 0 MAY BE OCCUPIED AS ` ACCORDANCE r WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND y SUCH OTHER REGULATIONS AS MAY APPLY. `"°RT;•ti° CERTIFICATE ISSUED TO d �I De� °f O 9 ADDRESS e++ +a Bu ding Inspector ,. t NORT 3 Town of � � � - � Andover .1' L No. 367 * _ ., - dover, Mass.,MV 1( 1* 191C 20 COCMIC EW1CK ' �p AERATED P'P�` 7 E /PJOARD OF HEALTH Food/litche PERMIT D Septic System THIS CERTIFIES THATL.�..0 ..b.414 .I,...�1f,.4..6dE6....... N � A- BUILDING INSPECTOR '�"'..i.............................................................. oundatio l0`S �c�� �1.D-I`' Z� has permission to erect..W.. ...Ff*MF_... buildings on .. 4. ...... .r.... �•••••••••••••••••• Rough lC S' l�9 �.� Chimney to be occupied as.a�1t�tGl�..: Tuvis 4.V.� t.nb� .. .. ...�...4A(L ..���,...................................... y provided that the person accepting permit shall in every re ect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. . PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. ( Y 'k I y/,,1 l 5 /- PERMIT EXP �-�� FEE PAID ELECTRICAL S�R CON U S Y d BUILDING INSPECTOR !A)_-0 Fin l rmit Required to Occupy Building GAS INSPECTOR � Display in a Conspicuous Place on the Premises — Do Not Remove (Jqa No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. ` FIR XPA R NT/ V Burner 1 _ vs R I J P NNING fNAL CONSERVATION � ` Street No. °� . � `�� Smoke Det. %CFIA/FR /IAIATFR 4:7-10 N 10 FIAI nRIVFWAY FNTRY PERMIT � ` �00 LOT 2 A=27912 S.F. 20.7' T.F. 195. 1-1 I � Oil` 6, 23.5' FOUNDATION- LOCATION PLAN I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REQUIREMENTS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRIC77ONS SUCH AS CLIENT.• COLONIAL VILLAGE DEV. ORDERS OF CONDITIONS,ETC.)NANI5,WETLANDS,EASEMENTS, THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY THIS CERTIFICATION /S MADE AND LIMITED PURPOSE OTHER THAN THAT OUTLINED ABOVE.EXCEPT WITH THE TO THE ABOVE CL/ENT. WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC AND ANY UNAUTHORIZED USE 1S PROHIBITED.CHRISTIANSEN & SERGI TAKES NO RESPONSIBILITY 'FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR- MAUON CONTAINED HEREON. LOCATION.SO.BRADFOED ST.- NO.ANDOVER A4A. H OF �q ego MICHAEL SCALE.• 1"=50-' DA TE:10/5/95 C s Ra, s�D ST CHRISTIANSEN ,h SERGI PROFESSIONAL RFESSINAL EYORS NGINEERSLAND } 160 SUMMER ST. HAVERHILLMA. 01B30 TEL 508-373-0310 @1994 BY CHRISTIANSEN 6.' SERGI INC. ' DWG.NO.:93042016 I ORT own of � � � - 4Andover.. No. , 3671 _tart, dover, Mass., 195 COCHICHEWICK ADf4ATED PPG BO 4 ARD OF HEALTH i Food/Kitchen Septic System PE_ R,, M1T T D ����� �� BUILDING INSPECTOR THIS CERTIFIES THAT��-Qt�A1�4llt ... 14i Foundation' has permission to erect-W ..AWE.. buildings on .. 4$...... .�.A...&AM'Q(&..3t .................. Rough { to be occupied ...................................... Chimney provided that the person accepting this drmit shall in eVe re ect conform to the terms of the application on file in P P P 9 P ry Final this office,'and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of,North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough , 1 Final PERMIT EXPO FEE PAID ELECTRICAL INSPECTOR UNLESS CON U S Rough ��, tA� .... .... .. .... ..........: ...... Service �ti�` BUILDING INSPECTOR � V Fit Occupancy Permit Required to Occupy Building ����� PECTOR Dis la in a Conspicuous Place on the Premises — Do Not Remove Q �ion n 'Display p A� al No Lathing or Dry Wall To Be Done o f FIRE DEPARTMENT' r Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT } Qn3 c.. &It_ Location No. Date Q 4 TOWN OF NORTH ANDOVER Of C O? 6 OL F ; Certificate of Occupancy $ Building/Frame Permit Fee $ �+s ACHU Eta Foundation Permit Fee $ salCMUS G, Other Permit Fee co` $ Sewer Connection Fee $ ' Water Connection Fee $ TOTAL $ t 4.v 4� Building Inspector �'C1�1 °Y9u tL�; S 104.00 PA 13, j 9480 Div. Public Works PERlirr NOAPPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 12 RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. �- LOCATION 5L �•, � PURPOSE OF BUILDING v ��N` / C1 TiC1� OWN'1R'S NAME �JV&L.. p ,, [•44AV � NO. OF STORIES SIZEj3[�0 OWNER'S ADDRESS ' �hG C� ,L, �) ID, i��N�v� BASEMENT OR SLAB - 1�•�) -ARCHITECT'S NAME •J 7 /V SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME9J1l VY2L-,VM-7 7-,ql SPAN --_— DISTANCE TO NEAREST BUILDING i �L•• DIMENSIONS OF SILLS DISTANCE FROM STREET 0 11 POSTS DISTANCE FROM LOT LINES—SIDES�.,7 REAR ' GIRDERS AREA OF LOT g /z 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 CODEYLw-!�7 IS BUILDING CONNECTED TO TOWN WATER C7 BOARD OF APPEALS ACTION. IF ANY 7�+ IS BUILDING CONNECTED TO TOWN SEWER ��Q IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST S� '71 CDPAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. S-0 `-' 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 APPROVE BUILDING INSPECTOR DAT D BUILDING INSPECTOR WI—GNATURk OF OWNER OR AUTHOFVZEn AGENT r . ,F E E OWNER TEL.# 292-23 0� o yyU PERMIT GRANTED . � � � f� CONTR.TEL.k �'� �"`d� 19�s�. CONTR.LIC.# �-� H.I.C.A ^/ © 4u DEC _ 7 c#4 pt BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM ~ MULTI. FAMILY OFFICESLOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ y, /, 1/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDSB 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD%r✓'D _ ASBESTOS SIDING COMMC:N VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR II POOR ADEQUATE NONE sj ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT A 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. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC 1st 13rd NO HEATING NORTH _r"126F 0 o J. L over O No. i4Z 2' L= rt " dower, Mass., ems, t8 1gq - �J CUCMICMEWICK ORATED PPP\ C� 5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System n/�_� �I ^ �� �` BUILDING INSPECTOR THIS CERTIFIES THAT..0ZL[aN,1lr?.L....�.11r1.,Arp.�»..��, rv.�.L.P1 .1.....................•............................... Foundation has permission to erect.SW...7ib0.%..,........ buildings on .. ... . ..... �. a •.•• ........ Rough ... ...........to be occupied as.. .x.a. Chimney provided that the person accepting this perrmit 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. T%U�b PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EX 6 MONTHS Final UNLESS CO STR NT ELECTRICAL INSPECTOR Rough .... ..... ............. Service BUILDING SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finallh No Lathingor Dr Wall To Be Done Until Inspected and roved b the Building Inspector. FIRE DEPARTMENT { .; P Approved Y 9 P Burner . � •., LL Via: Street No. Smoke Det. q� . FOM( U - LOT RELEASE FOR14 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: ( 0L(5XtAL_ Ytwe�i. ��L6¢.' Phone LOCATION: Assessor's Map Number Parcel )64�Subdivision Lots) Z_ - V Street 548 go. t�6ZAD �� St. Number J44 ************************Official Use Only************************ RECOMMENDATIO S OF TO AGENTS: / ,l Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date 0 T 2 C A= . 12 S.F. \ T.F.— 195. 1 ' S 35.3' o • Nrn JJ.4' / r o .o. �0 23.5' Ilr:f` — 7 FOUNDATION LOCATION PLAN THE HOR/IONTALTHE SETBACKARY REQUIREMENTS of THE LOCAL APPLICABLE.ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS.WETLANDS GSEIIENTS. CLIENT: COL QNIA L VILLAGE DEV ORDERS,OF CONDITIONS.ETG.) THIS DRAWING SHALL NOT BE USED or,THE WENr Aw ANY THIS CERTIFICATION IS MADE AND LIMITED PURPOSE OTHER THAN THAT OUTLINED ABovrrxccrr WITH rmr WRITTEN PERMISSION OF CHR/STUNSEN # SERGI ANa TO THE ABOVE CLIENT. FURTTI£RMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHR/STIANSEN * SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBITED.CHRISRANSCN R SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR= AIATION CONTAINED HEREON. LOCATION:SO.BRA DFOED ST.'—", NO.ANDOVER,rNA. q H Of MICHAEL SCALE: I"=50' DA TE.10/5/95 Rc�. /.l OSS• CHRISTIANSEN T SERGI LANDSIONAL 160 SUMMER Sr. HAVERHIU.MA. 01830 TEL 308-373-0310 ©1991 BY CHRISTIANSEN & SERGI INC. DWG.NO.:9.3042016 ENVIRONMENTAL POOLS, INC. Chelm�RMA 01824 Design Excellence 2Uds;b cfersonW k-) Tel. 508-256-M 0260 SWIMMING POOL CONSTRUCTION PROPOSAL THE GENERAL TERMS AND CONDITIONS ON THE REVERSE SIDE ARE PART OF THIS AGREEMENT NAME (Buyer) ►R- �' �t�� .S�AT�L� tl `� MAILADDRESS 901C3,9LiHl &44 CITY - ieLee- STATE 1W,ZIP 8X HOMEPHONE 682-25W JO ADDRESS =54� n Rat 'o2n CITY Xi- STATE R ZIP BUS.PHONE ooA- STRUCTURAL SPECIFICATIONS FILTRATION EOUIPMENT SPECIFICATIONS _ Make-l�.. 1) Engineered Structural Plans and Working Drawings.....................:. Included 35) N.S.F.Approved Filter;Type Size .. Included 2) Establish Shape,Elevation and Location Prior to Excavation............. Included 36) N.S.F.and UL Approved Pump and Motor; Size 112- MakeJs&L .. Included 3) Perform Normal Excavation and Remove Soil on Dayof Excavation Only.... Included 3i l Hair and Lint Strainer for Pump Pot...................................... Included 4) Hand Form and Shape Pool.............................................. Included 3t;) National Electrical Code, U.L.Listed Time Clock ......................... Included 5) Access Wall or Fence: Removed By...... .. ll.,,,./ 39) Electrical Wiring and Connections ...................................... . Replaced By......t !��?.•.....•.....•••. 40) N.S.F.Approved,Automatic Chemical Dispenser ......................... 6) Remove from SiteLoads of: Trees,Stumps,Shrubs, / i 41) Pre Formed Base Slab for Filtration Equipment .......................... Included !I Asphalt,Conc ete,Other Debris.................................... 42) Automatic Pool Cleaner; Make ........................ o 7) Steel Reinforcing Per Engineered Plans ...................—..y...x.�......... Included 43) Stainless Steel Separation Tank; Size .......................NO 8) Electrical Bonding of Reinforcing,Jigs and Equipment.......F.�1 U1,.. .By-Swyer 44) Sixwav Multi Port Valve.............................. Included 9) Monolithic Gunite Structure(to meet or exceed local or state codes).,... Included 45) Approved Heater,Type BTU ..:....... C- 10) Instal Continuous Bond Beam Arounet Skimmer(s)........................ Included 46) Fuel Connections, Heater Venting,Fuel Storage Tanks, Permit. .......... By Buyer 11) Water Cure Gunite Shell Twice Daily for Seven ays................... Buyer 12) One Set of Shallow End Steps withX Bench1 1 -J.?11.......... By Included MISCELLANEOUS SPECIFICATIONS 13) Swimout or Love Seat..:. .. ).••••••.•••••••••••••••• ` 4-l) U.L.Approved Marine Light;Watts < volts /�.............. 14) Grading or Backfilling...,WI;.....c�'.!y..••••••••••••••• '• - 15) One 6" Band of Water Line Tile: Color Type To 48) Up to 10'of P.V.C.Conduit and Deck Box for Light....................... GC�- 16) Deluxe Safety Grip Coping.......... 49) Re Routing Sanitation,Water Supply Systems and Utilities............... By Buyer 17) Provide Cantilever Forms for Dck Edge .... 50) Flush Mounted Anchors,Safety Rope, Floats............................. Included 18) Finish Pool Interior with ������ ................ Included 51.) Payment of All State and Local Taxes During Construction............... Included `- ' 5�s) Negligent Property Damage, Public Liability,and Workmen's 19) Filling of Pool Promptly after Interior Finish Application .................. Buyer Compensation Insurance During Construction..................... Included PLUMBING SPECIFICATIONS 53) Transferable Structural Guarranty....... ........:....................... Included V 54) Stainless Steel Ladder................................................... 20) Non Corrosive Plumbing and Fittings Throughout.... 1. ..�....... Included 56)_ 'Stainless Steel Rail ...................................................... 21) Self Adjusting Surface Skimmer ........................ Included 56) Diving Board; Size 'Type Color ............. 22) Vacuum Adapter in Skimmer..:...... ................................. Included 57; Slide; Size Color Curve — ...: __,[_>F= 23) Leaf and Hair Strainer Baskets for S immer� d� ......................... Included 56) Slide, Ladder, Rail,and Board Jigs Installed......................... By Buyer 24) Pressure Return Inlets to Pool_ .............................. Included 59) Water Condition$ 0 Charge Pay to Excavator ................:... By Buyer 25) Direction Adjustable Return Inlet Fittings ................................ Included 26) Locate Skimmar(band Returns to create Cross Pool Surface START UP AND MAINTENANCE Cleaning Turbulence............................................... Included 27)'`Mein Drain Grate and Cover Grill.................................................................... Included 60) .Deluxe Maintenance Tools(nylon brush,leaf skimmer,telescoping 28) Direct Main Drain Suction Line Between Pool and Filter................. Included - pole,test kit,thermometer,vacuume head 8 hose)................. Included S^"sca'!ng N, mctu'ic Pressum Re!fef Valve .................. Included 61) Start up and Maintenance Instruction.................................... Included vv..Jou:.... - _ 30) Install Piping and Fittings for Future Pool Cleaner........... �CJ- 62) Start Up Chemicals(10 lbs. Diatomaceous Earth,2 Gallons Acid, 31) Flexible Hose for Pressure Backwash of Filter Media ft. ..... � 32) Up to X Plumbing Run Between Skimmer and Filter A:!>.i>..!4". Included 33) Pressure Testing of Plumbing Lines during Construction................. Included. .� j�ADDITIONAL tPECIFICATIONS 63) lQ./7 �TO/�� O/�oe kf 64) - !E--PA /J-c,. bm-4t " 65) 66) 6 7) 63) . 69) F + NOTE NO VERBAL AGREEMENT ACCEPTED. POOI Deck PITCeS (Gradin N Ot In luded) You may cancel this agreement if it has been consummated by a party ROCK SALT OR BROOM FINISH �� S . Ft. thereto at a place, other than an address of the seller, which may be his main COOL DECK FINISH _Sq. Ft. office or branch thereof, provided you notify the seller in writing at his main (Above prices valid for 30 days and are not included in pool office or branch by ordinary mail posted, by telegram sent or by delivery, not contract price. Bluestone,Brick,Lockstone,Futura Stone Decking later than midnight of the third business day following the signing of this prices available on request) agreement. Owner agrees to pay the contractor the sum of $ Down Payment $ Contract agreed to by Contractor and Buyer Balance $^/ � `-•'`w Buyer. owner U PAYMENT SCHEDULE Buyer J er 40% Day of Excavation $ �aJ Ems% Day of Gunite $ 'Contractor epresentative v— p ao Prior to Interior Finish Application Any amounts indicated on other contracts with 1(j GvQ this company are in addition to this contract amount. Total $ Accepted This A&K Day of _--kc) �/ ,) NOTE NO VERBAL AGREEMENT ACCEPTED. THE WARRANTYS, GENERAL TERMS AND CONDITIONS ON THE REVERSE SIDE ARE PART OF THIS AGREEMENT. BUYER ACKNOWLEDGES THAT HE HAS READ AND UNDERSTANDS BOTH SIDES OF THIS AGREEMENT. I Location s ��L-)� No. `�� Date t pORTIy 1 TOWN OF NORTH ANDOVER r 3?O'�,690 K A Certificate of Occupancy $ r + Building/Frame Permit Fee $ 43 - too''t� Foundation Permit Fee $ s�cwust Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ( 3 Building Inspector !1[15 95 12:52 143.00 PAID l:.' 9305 Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. I LOT NO. 2 RECORD OF OWNERSHIP "DATE BOOK "PAGE — ZONE SUB DIV. LOT NO. �— LOCATION o{ �7Q „ l� �J <3-7— PURPOSE OF BUILDING OWNER'S NAME / ���Yv NO. OF STORIES SIZE � OWNER'S ADDRESS -�7 Q 1 ../l a S� BASEMENT OR SLAB - ARCHITECT'S NAME / y/�`i�� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME //'.,en? SPAN -- DISTANCE TO NEARESTBUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET '�) f ,J POSTS DISTANCE FROM LOT LINES-SIDES -3� �S C REAR l " GIRDERS AREA OF LOT �� Qj! 7 FRONTAGE �C,/�7 J1 HEIGHT OF FOUNDATION THICKNESS ` _ IS BUILDING NEW !! OGS. �L/ 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 //VI,) yJ//✓QI�IQ/✓ LAND COST SEE BOTH SIDES ! /v O ) EST. BLDG. COST 2 2--o O O i'l PAGE 1 FILL OUT SECTIONS 1 - 3 /✓ EST. BLDG. COST PER SQ. FT. l/ �w ' PAGE 2 FILL OUT SECTIONS 1 - 12 7 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 fi DATE FILED /i/� / BUILDING INSP[CT+OR SIGNATURE OF OWNER OR AUTHORIZED AGENT fa ��/J f FEE OWNER TEL.k Z,2- ,/ 2 PERMIT GRANTED _ �� CONTR.TEL. �/V L rL 19 -lam l - ��y �. CONTR.LIC.# L — � b H.I.C.k 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- t APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE d 1 7 13 CONCRETE BL K. PINE _ BRICK OR STONE HAI PLA'ST — PIERS PLASTER _ -FRY VJALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ y, 1/2 •/ FIN. ATTIC AREA _ N_O 8 M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARD$ B 1 22 f 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVJ'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. b FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT I A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR E�l TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE 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 151 13rd NO HEATING NORTH F � Town of Over 0 0 rn No. 541 o � brt dover, Mass.,Q 3 d 199 ISN COC HIC MF WICK V A()RATED '�C.) `-' BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... '� x ...... AA , 1 .?1.............:........................................ Foundation has permission to amt...A.CAR.................. buildings on ...��t...... 744D C�...Si ......... ough to be occupied as.. -tb4.. �IF.N!11E.b.�i -.... X .... Chimney . . .. . . . . . . provided that the person accepting this permit shall in every respect cont rm to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXP 6 MONTHS Final UNLESS CON TR �' ELECTRICAL INSPECTOR Rough Service BUILDIN NSPECTOR 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 I Street No. t Smoke Det. i ti 78' 10'4'4' '6' 16'6' i 4'10' '10' 4'3ho 6'04'4' J J [ Sr jJ ao0 w m N ■ ^ cil ■ l J Q [ '6' i •� 8'0' I 1 w o� �Y at w • • 14'0'4' CA 510'SLUNG � w ' CLOSET CLOSET 14'0" 5'0' SLDNG N � 7'0' w n w G 1 �+ O w � N 7 z 7 T 7 3 ' J [ N 28 I I I 1 N i� O N N f N y V l7 V � wi •�, � The Commonwealth of Massachusetts orrice use Only 7p Permit %0. Department of Public Safety tti omr-aecy i Fee °uwW l,hG BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12.00 3/90 (leave blank) : APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Aork to be performed In accordance With the Massachusetts Electrical Code.527 CMR 12: U W (PLEASE PRINT IN INK OR TYPE/V/BALLXRTION) Date � �City or Towb of • )" To the Inspector o wires: The undersigned applies for a permitt to perform the electrical work described below. Location (Street & Number) � /e d 5&4A� 1 /&/ Owner or Tenant l-4) )(/Y)/-a 0A., `t-l" 92=d� Owner's Address Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building ,__1 /'J 9CfAJ d CI'r171,,4 rWX Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Heters New Service Amps / Volts Overhead ❑ Uodgrd❑ No. of Meters Ntmber of Feeders and Ampacity, Location and Nature of Proposed Electrical work No. of Lighting Outlets No. of Bot Tubs No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above RVA 11> d. ❑ Generators . No. of Receptacle Outlets No. of Oil Burners No. of Emergency LightingBattery Units No. of Switch Outlets No. of Cas Burners FTS ALLIOS No. of Zones Total No. of Ranges No. of Air Cond. oNo. Detection and ns Initiating Devices No. of Disposals No. of Heats Total Toil No. of Sounding Devices P=PNo. of Dishwashers S ace/Area Heating XW No. ec Sol Contained D P g Detection�Sounding Devices No. of Dryers Beat Devices Xi Local Municipal Other Dry Heating Connection❑ No. of Water Beaters XW No, ° o. of Low Voltage Sims Ballasts Wirinit No. Bydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Lava I have a current LiabilityInsurance Policy including Completed Operations Coverage or its substantial equivalent. YES* NO I have submitted valid proof of same to this office. YES❑ NO ❑ If you have checked MMM please indicate the type of coverage by checking the appropriate box. INSURANCE S BOND ❑ OIBER❑ (Please Specify) MERCHANTS. TNgbRANf'F 96 (Expiration- ate Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed a..aer the penalties of perjur;: FIRM NAME LIC. NO. Licensee GREGORY TAYLOR Signature LIC, NO.32268F. Address 4 SAN MATEO DR.CHELMSFORD,MA 1824 Tel. No. 508-250-0017 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or is su - stantial equivalent as required by Massachusetts Generalws-Ta,and my signature on this Pqmit application waives this requirement. Owner Agent (Please check one) j�� Telephone No. PERMIT FEE S 1V Signature of Owner or Agent i -.t°...--.w.-,;,y,,,�.:.b'1;�'�,.�-.y. �F1N-�"'�'1.-�'riV►�srin.:J..�2L�-^.,1:,.-�-..^'k :,T7."i:'J►jrr^�e _,�:M`....,,viti-!=^ �-' - G3 - Date.................................. �T 2974 t NORTH 1 TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ,SSACHUSEt f, This certifies that ......A.... .. ..l..l�. .................... has permission to perfor ,.I.. : . wiring in the building of .: ..N (r............ . ....,� .1 ..... O (^ NorthPmdover,Mass. Fee.�C..�: :.... Lic.No Z �......... ELECTRICALINSPECTORI, 04/0419111:423500 pp ii�n WHITE:Applicant CANARY: Building Dept. � PINPReasurer GOLD: File 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) t C NORTH ANDOVER Mass. Date �uilding Location �yK Sv,jill lit,4011<1 S r Permit # H Owners Name ' New 1 Renovation Replacement Plans Submitted FI XTUREc N � a W y '4z m oc 01 CC m a v as r x rn a a x x o I.. cc �. d 4 O Q z W Cr N 4 W Q z W FO- tp sL = y 1.- , a W Z z Q Z W oC cUS 0W7 a W r W u x M ¢ Ir W J < a .9 yt".. O m z O z W d to 7C < ,u > C W z C: < cc— a x o O z u. A c7 .at v s >- ca a I-- O SUBt-8SMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR I FF 6TH FLOOR 7TH FLOOR 8TH FLOOR - (Print or Type) Check one: Certificate Installing Company Name �r, S I ��S P�' �I Q Corp. Address 1, e� = Partner. 0-00,L-4 Y1�5 6 ) 'St,7 LQ Firm/Co. Business Telephone: (� i'7- (7W Name of Licensed Plumber or Gas Fitter (0- (,� a`�T LZ,-�S Insurance Covera e: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ar-other type of indemnity F-1 Bond F1 Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of thc, above three insurance coverages. Signature of owner/agent of property Owner 17 Agent i hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and ceurate to the best of my knowledge and that all plumbing worst and iniullations performed under"Permit isseed to: this application will-be In mp' nce with all pestlnent provisions of the Massachusetts State Gas Code and Chapter 14I of mho General Laws. By TYPE LICENSE: lumber Title Gasfitter- ignature of Licensed City/Town: Master 1 tuber or Gasfitter Journeyman _ NJ APPROVED (OFFICE USE ONLY) License Number :��► . MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFiTTING (Print or Type) ! Mass. Date 19 Permit # 2 O 13 Building Location S � Owner's Name 00T Type of Occupancy SINGLE FAMILY New O"" Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No'❑ FIXTURES h H W Z " 'n v5 pu � z2e"c 2 m h � W fl C 116 W to Z 7. 0"G ya �u < eC t ~ r nl m 0 0 y SUB-8SMT. BASEMENT L i ]st FLOOR i 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR installing Company ,Name ' GALINSKY PLUMBING & .HEATING INC. Check one: Certificate Address P•0•BD% 1701 M Corporation 1906 HAVERHILL, MA 01831 ❑ Partnership Business Telephone 508-374-1743 ❑firm/Co. Name of Licensed Plumber or Gas fitter STEPHEN C. GALINSKY INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes)e No;o If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policyy, Other type of indemnity❑ Bond 0 OW:NER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. Gen_-al Laws,and that my signature on this permit application waives this requirement. Check one: Owner•,_l Agent = Sid nature I he-e`,cern led,e and that a�'plumbinti�M,-k ij.jj ry Date: X1 1. ..... .. d p1,ap;er 142 o:nc General 1.2.s Et /Y „ORT„ 1 TOWN OF NORTH ANDOVER Q5 Fret —0— Trnr 3?pyt �eo ,e -yet p PERMIT FOR GAS INSTALLATION "S CH This certifies that . . .62./-? s.!�Y. . . . .'.�. .. . . . . . . . . . . . . . . has permission for gas installation . . A).0 � . ./4c: -!�:r=. . . . . . . . . in the buildings of . . .Vb.A&-c-'r--.6?: . . . . . . . . . . . . . . . . . . . . . at . . -5-.9.c-. . . .lu c; ;��. . .)3.0141 .&1.,4gorth Andover, Mass. Fee. . . . Lic. No.. . . . . . . . . . 12/15 /95 14:34GAS INSPECTOR ' 70.OQ PAID WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File s..f L FINAL INSPECTIONS SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING E LOCATION OF BUILDING ,s PLUMBER OR GASFITTER UC. NO. PERMIT GRANTED f Date 19 Gas Merc. Final Insp. Gas Inspector ... .-..:L-- _. ..r,.�wr:.�.,1.Vt++�'s�'+'^^air .,:,y.:��ti.-i'Y'4_'^�'i'dH-:A-s:e-�.d...�a'. r -•.. `t_' .i.a .-�., .. TO 2200 mate.. .. _ o - NpRTM TOWN OF NORTH ANDOVER g f 1 p , 6. t0 F� e`x.60 6 Op PERMIT FOR GAS INSTALLATION s oq �9SSACtHUSEt 5 This certifies that has permission for gas stallation . . . . . . I . . . . . in the buildin s of .Z�. .� ( (1 at• 7. .44'� � JG12� .,J�., North Andover, Mass. Fee. e/5 °U Lic. No,.q5 ^„tl 20 GAS INSPECTOR WHITE:Applicant Y: Building Dept. PINK:Treasurer GOLD:File It G Office use Only / uof Supe Permit No. , levar=znt of Vuhiic Oaft2g occupancy A Fee Checked --104- 31gp BOARD OF FIRE PREVENTION REGULATIONS 527 C,JR 12:00 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 52LZ-- ,?-1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date a To the Inspector of Wires: F qqw or Town of NORTH A DO R The udersigned applies for a permiitt.to perform the electricai worts described below. 1-2 Location (Street & Number) Owner or Tenant 12�T' /�(//1 ,Of X� Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purccse of Building Utility Authorization No. ' Existing Service Amos ! Vcits Overhead '_ Uncgrnd r No. of Meters New Service Amps _1 Voits Cverhead _ Unccrnc No" of Meters Numcer of Feeders anc Ampacity Locaticn anc Nature of Prccosed Ei.ectr'.cai `,Vc- -5;46 /?�✓ .1L 13 2 ota+ No. of Lighting Curets No. o —. mac: ...cs No. of ransformers� K`:A No. of Lighting F xtures i Swimming P_ci �o e- anis _ Generators KVA No. of Emergency Lighting No. of Recectac:e Cutlets I No. of Oil currers I Battery Units No ,f Sw ion Outlets No. or Gas =_rner<_ ( FIRE ALARMS No. of Zones otat TNo. of Cetecnon arc No. of Ranges No. at Air Cara_ tb^s I Initiating Cavices " Hea: ictal Total i N..af No. cf Souncin No. of Cisoosais Pt;-cs ahs �N g Devices No. of Sarf Contained No. of Dishwasners ScaceiArea jeanrg K`VJ Oetect:oniSouneing Devices Munic:oat Other No. of Orvers Heatinc Cevices K�V Local _ Connec::on No. at No. of I Low Voltage No. of Water Heaters KW i Signs Ba;iass Wiring No 'Hvcro Massace u s No. of V1ctcfs 7b-a; CTHER: INSURANCE COVERAGE. Pursuant :o the recuirements at aassac-csetts gererat Laws 0-'NOI have a current Uaetiity Insurance Policy inctucing Corn-:et Cce-a::ens Coverage or its substantial ecwvaient. YES nave suomrtea valid proof of same to the office. YES NO = if you nave cnecxee YES. please inoicate the type of coverage by cnecxing the aocr rlate cox. INSURANCE _ 3CN0 = OTHER = (Please Spec`+1 (Execration Dam s' Q��, Est:rnatea Value of En ec kat WorK S � Wcrx :o Start 3 G Inscecaon Cate Recuestec: Rough F nal Signeo anter :he Penalties of perjury: =RM NAME SULLJvi��v / �/1< C/�n� LIC. NO. a �5 sig-attire �G'�� a UC. NO— y !� Bus. Tel. No.s�� ��' F Y7 Address 2? ���(��� J Alt. Tel. No. OWNER'S INSURANCE WAIVER: 1 am aware that tre Licensee Coes not nave the insurance coverage or its suestanuai eautvalentt es�re- quaeo by Massachusetts General Laws. and that my signature on w.:s ;errnit aoptication waives this requirement. Owner Ag (P!ease cnecx ones 3 Teiecrcne No. PERMIT FE: s (Signature of Owner or Agents t"" Date.../... ...- .. .... .. F ', ' 2802 f �aOR71,1 TOWN OF NORTH ANDOVER Q PERMIT FOR WIRING a � o�+ ,,,`mow• -TS AcmUSEt This certifies that ....... .Lt..�.��.. t1Q h .1 ./? .. . ................ . :......... . . . ' has permission to perform ...........................:: . ..�.............�.y s....... wiring in the building of....... at........�.... .....�Ij..t .�.A......!.�� arc �.`.'.:"!...... ,North Andover,Mass. Fee...-3.�'.: ... Lic.No. .... ..t f.5 ............................................................. ELECTRICALINSPECTOR C WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File . .. .office Use Only77 . - � 1 - Permit No. E Tlimmnniumlt4 of ask 4 3 s -= lepartlnm of f uhlit tf>ag ._ Occupancy A Fee Checked F 3MO heave 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 T& 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) y� Sov�/� �/�/y/J `��/J S '/��J Owner or Tenant G V//./IA-s/11 PA�/�l�i,> Owner's Address 7el Z s�'L�3/ t�y�1�FT /f!` A'�y/�c✓/�/i M� fl a/lY�f Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization t No. Existing Service z f Amps/-&' / Z�lc Volts Overhead ❑; Undgrnd Lam'" No. of Meters New Service Amps _! Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 14;//w �z`y /, G No. of Transformers Total No. of Lighting Outlets i No. of Hot Tubs 1 KVA Above—, In- (1p� No. of Lighting Fixtures Swimming Pool grnd. grnd. 'd I Generators KVA II No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Air Cond. No. of Ranges I tons Initiating Devices No.of Heat Total Total No. of Disposals I Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal r-^Other No. of Dryers Heating Devices KW Local ❑ Connection i No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts I Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the reawrements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES jj� NO = I have submitted valid proof of same to the Office. YES ;4 NO = If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE � BOND OTHER = (Please Specify) (Expiration Datet Estimated Value of Electrical Work$ Work to Start �0 /J- yr Inspection Date Recuestea: Rough VY)1�iL 41-4 I- Final Signed under thePenalties of perjury: yJ FIRM NAME P ���! /✓! LIC. NO./> -& Licensee Signature 7 q LIC. NO. /u ® / 19 Bus. Tel. No. / ���LZ Address /��N !`� �l✓� Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- OWNER'S by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Age t (Please check one) Telephone No. PERMIT FEE S VVV (Signature of Owner or Agent) x•6565 Date. To 2772 NORTH °` °;°'S° TOWN OF NORTH ANDOVER o4L _ PERMIT FOR WIRING lo US f This certifies that .... ....... .......................... has permission to perform ...... f.......10.0.4..................�/.................. wiring in the building of.......Cal.... J.a..l..t...... ......(.'C)n/-*....... at.....,.i..yr..5th........�' a'tt-a.......:................... .North Andover,Mass. ��Fee... r... Lic.No.41067-1 K.......................................................... ELECTRICAL INSPECTOR '7f� 12r19J�95 13:32 35.40 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File w . : .0 office useany mV � Permit No. evarbax>i »f tthlit ; ttfE2g Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 Heave blank) x ' _ APPLICATION FOR PERMIT JO 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 QW 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) / Owner or Tenant GSL"/✓//zU /L'G�/�(��Z/��i�l`�/7/1. '� Owner's Address G/L S/,�/i/>ri� 5�`/>rf� /` N� �a i�/��✓/�i Is this permit in conjunction with a building permit: Yes 7 No Q (Check Appropriate Box) i(/Jlly' f /�/ Utility Purpose of Building Y Authorization No. Existing Service Amps _� Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service _ Amps X- 2�4 Volts Overhead ❑ Undgrnd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /7/ l✓/tr�' �� ` /y/l No. of Lighting Outlets I No. of Hot Tubs I No. of Transformers Tota! KVA No. of Lighting Fixtures I Swimming Pool Above—i In- grnd. L_ crnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of es Ran No. of Air Cond. Total 2 No. of Detection and 9 tons 7 Initiating Devices No. of Disposals I No.of Heat Total Totai Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices Municipal �— No. of Dryers 1 i Heating Devices KW Local }�/1 Connection (_ Other 1 No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I-No. of Motors Total HP { OTHER: INSURANCE COVERAGE: Pursuant to the reautrements.of Massachusetts general Laws / I have a current Liability Insurance Policy including Comcieted Operations Coverage or its substantial equivalent. YES t[ NO = ! have suomitted valid proof of same to the Office. YES 1Z NO = If you have checked YES. please indicate the type of coverage by checking the appr9priate box. INSURANCE BOND = OTHER lZ' (Please Specify) (Expiration Date) Estimated Value of E!ectrical tWork 5 2- Work to Start / Ik /)S Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAME G IC. NO. L1L_ Licensee Signature LIC. NO. Bus.Tel. No. J �a',y�7nZ Address �d / ��f�v� /� v'` /!L M/1 ff Alt. Tel. No. 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. Owner Agent (Please check one) 19 Telephone No. PERMIT FEE 5 �jr (Signature of Owner or Agent) x-6565 G C/ f / O /7 2773 ��9*��j Date.......... ......... ........ f NORTH 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SAGNU`�Et This certifies that ......LeG� .......... 4,-c- ...... L. ......................................... has permission to perform ......N:P...t'j...:...Ram..'......s,,�a�.'2..�.✓�.y...... wiring in the building of.... ��.........� .LAA.........��.�.J�.�........�Q.�............ at....�... ��.SLI .fi ....f�.eu I�.......:................ .North Andover,Mass. Fee. 5. -.O�.... Lic.Nof./061K............................................................. ELECTRICAL INSPECTOR C I( 119/95 13:31 500.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File