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HomeMy WebLinkAboutMiscellaneous - 59 BERRINGTON PLACE 4/30/2018 C3-) 7 i� Date: June 28, 2016 20690 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointoloud.com/#/records/20690 •- . TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING .. I a This certifies that Joseph A Spinale has permission to perform Rear Screen porch. outlets and lights wiring in the buildings of ROTTER, MICHELLE. ANN at 59 BERRINGTON PLACE_, North Andover, Mass. Lic. No. 38463 1/1 Date. ��`�-�..... ... NORTH 3� a TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION o••" qy -ISS CH This certifies that . . . 'eo{ . . . . . .rc. . . . . . . . . . . r. has permission for gas installatio 's. . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . .. . . . . at . . . . e'. . rrl P ..filq� North Andoveir,Mass. Fee -s6: ` Lic. No.. 3. . . �G!. . !?n�r�:!. . . GASINSPECTOR Check# 8295 ri MASSACHUSETTS UNIFORM APPLICATION FOR PERNgT TO DO GAS FITTING City/Town:_/Yd• AN�11" .MA. Date: / Pemtit# Building Location: Jr / &!ko/ 40 .Owners Name: Type of Occupancy: Commercial❑ Educatjonal❑ industrial❑ InstituEional❑ Residential New.❑ Alteration:❑ Renovation:❑ Replacement❑ Plans Submitted: Yes❑ No❑ FIXTURES er Z Y z o W � . o`oc z o . g oc a9 Z o 5 o fA w o ,� H o a o o M � W W Z p� = W U. W OC V W Z � � F- P r t9 U. � = I IW u o n 0 o s z g o 9L ' > > > 3 0 SUB BSMT. BASEMENT T FLOOR FLOOR TO FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR jr FLOOR installing Company Name: Check One Only Certificate# /�/Y.e��/,�lh�?iiNr.� � � �O•�• . Address:ijOJ3�6',F/1id1SE�D CitylTown: �,E ,Fit/ State: . [9�c.rporaSon a ❑Partnership Business Tel: 645-- iMM Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: (9 INSURANCE COVERAGE: I have a current flabillminsurance policy or its substandai equivalentwhk:h meets the requirements of iNGL Ch.142 Yes No❑ if you have checked Yes.please indi the type of coverage by checking the appropriate box below. 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 She Massachusetts General Laws,and that my signature on this permit application walves this requirement: Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box ;i hereby ceift that all of the details and inIbnow on 1 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 an Pertinent provision of the iNassachusetts State Plumbing Coded Chapter 142 of the General Laws. TyW'of License: BY iff Plumber s Te Ma� Signature of Lidlinsed Plumber/Gas Fitter Cfty/Tmn Journeyman License Number: 34W3 APPROVED OFFICE USE ON") ❑LP installer r y� The Commonwealth of Massachusetts t-= Department oflndustrial Accidents Office of Investigations 1' `i ' 600 Washington Street -�-y Boston,IIIA 02111 wipIP.mass.gov/ria Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly r0 _ Name(Business/organizadon/Individual):� Address: D f City/State/Zip: f Phone#: .�`�.�� Are/you an employer?Check the appropriate box: Type of project(required): 1.LIQ 1 am a employer with_ ,p _ 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. [] We are a corporation and its 10.0Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additibits ' myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152;§1(4),and we have no employees.(No workers' 13.❑Other comp. insurance required.] Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy infonnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must nuached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. 1 ant an eitiployer tltat is provitliag)porkers'contpensatioii itisttrattce for tap eirrployees. Below is thepolicy and job site information, �y/ Insurance Company Name: /'/p J2 /,f f /��,r� • Policy#or Self-ins.Lie.#: !2( a � y�IG Expiration Date: /20 Job Site Address: 6�_'&�/Ne— City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify rtt er the pains and entrlties of perjury that the information provided above is trite and correct. Sip-nature: Dom_ Date: o Phone#: — .3 Official use on1J. Do not sprite in this area,to be completed by city or to)ptt official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Q Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an emplayee 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 cupant of the owner of a dwelling house having not more than three apartments and who resides therein,or the oc 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 cominonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall ' enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please Fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. Citv or Towri3Officials Please be,sure that the affidavit is complete and,printed legibly.-The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as,a reference number. In addition,an applicant that nmust submit multiple permit/license applications in any given year,need only submii'one affidavit indicating current policy information(if necessary)and under"Job Site Address"the npplieant 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 pennits'or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you-have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#.617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.miss.gov/dia t �' "�°T•'�o - TOWN OF NORTH ANDER PERMIT FOR PLUMBING CHUS• ,`+ j� This certifies that .` .`/ .. . .... ! ? . . . . . . . . . . . . has permission to perform Z.,��c., _ jrr- !��. . . . . . plumbing in the buildings of . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. 2 �- 04G Fe'e . . . . . . . . . . . . . . . PECTOR Check # n� �D r SACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING /Y�Dyt MA Date: �� Permit# ��N�70N-T�-r Owners Name: �� � /�ONNVcy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [ tion:❑ Renovation:❑ Replacement: Plans Submitted: Yes❑ No [ FIXTURES z z rn O j Y U � z CO z ta- z X rn Z Q Q _Z Q rn Z a w ~ w Q Y to In rn w D Q I" z } z rn cg U CL o w Q rn Q w O Q Q w rn J CO Z O O H S = z Q u- Q Y Q = w w Lu w U) � o a o > > o 0 o z z rn _ Q Q Q m m o o w O = Y _j � c=n n o SUB BSMT. BASEMENT 1 FLOOR Z FLOOR 3 FLOOR I 4TE 4 FLOOR S FLOOR 61 FLOOR 7TH FLOOR 8 FLOOR I I 'It— ...- lag f��i9��� �� i/��� Check One Only Certificate # Installing Company Name: � ,C /t/ P -or poration Address: City/Town: � L{3��4M State:� � � ZiCode:—_t�� ❑Partnership I Business Tel:9;� T'7l 0 Cell:� 07-f�,Q Fax _ ❑Firm/Company Name of Licensed Plumber: L INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalentwhich meets the requirements of MGL.Ch. 142 Yes No [ If you have checked YJ please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of th I Massachusetts General Laws,and that my signature on this permit application waives this requirement_ I Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of m) 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. By Type of License: Title umber Signature of ens Plumber City/Townaster I APPROVED OFFICE USE ONLY []Journeyman License Number: /b�� Date.. ..`''-CS /D .... f NORTH 1 O�pa �OT TOWN OF NORTH ANDD ER ' PERMIT FOR GAS INSTAL TI � s ' • 9SSACNUSES This certifies that . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation : . . .../4/4�;. . . in the buildings of . r . . . . . . . . . . . . . . . . . . . .. . . . . . at �,P. North Andover, Mass. Fee,-, . ... . Lic. No..� �Y. ,✓`�'� �11�P-CTdl Check# Ti 49 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:. �l,/ 1�Dd � Date:3- Permit# Building Locatic. 7 ��"f^�`/M�O��7 ��• Owners Name:_R/n- p4/04 AV Type of Occupancy: Commercial Educational Industrial Institutional Residential New: Alteration:_ Renovation: Replacement:`/ Plans Submitted: Yes No FIXTURES tY to w IY Z w U) U Q D LU W W O I- ln = 0 111w U (n I" (q W W w Z Q azO z U) W QO D O Ly 0 = U> UZ wU) Q U) O w Lu o LU Z W w H F- O z -.� 0 u- h=- w H w W O Q tr w w Q > 00 Q 00 W z W Q Q d l= 0 A DILL t9 C9 r = O a a: f- > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR- 3 FLOOR 41 FLOOR 5 FLOOR , 6 FLOOR -i'FLOOR . 8 FLOOR I Check One Only Certificate# Installing Company Name: jWP^IC/ 4—Corporation Address: g ��a Ot 40- City/Town:.��CnI/�G�� State:�g Zip Code: Partnership Business Tel:.%/� Cell: 976^Fa?-0W F Firm/Company Name of Licensed Plumber/Gas Fitter::.. INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes _YNo If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. I 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By dumber Title is Fitler Signature of Liodi lumber/Gas Fitter Master City!Town., Journeyman i LP Installer License Number: APPROVED OFFICE USE ONLY BUII:DIl�TG DEF, . I. APPUCAMNTO-CONKR REP REKOV AONSORTWO F K ,DW LXD(G BuIE.nINGPERMrrnnOM- .. ._.... DAA •.., .. . . . rn SIGNATLME: B f of 'ildizoDate._ SECTION 1-STTE DWORMATION Z 1.1 Peopatty nddeo= T3' Asmoi Map and Prod Number. O Ll Nn�er � ParodNumba. t3 zam�;eo 1.4 Pity n,mmr�,.. 7mingDkrid Propow Uft A Ara - g 1.6 BI I ING SETBACKS ft Front Yard R=YAW.- ROWiMd ... ...: Provide L7W&U,S.A*M .t.a+a Sl) P,.FbadYAW riffirawlm_ ._.. . t t._..Seerae�sDapoplSym� eetc o raV.e ❑. oabaa+ so.r ❑ SECTION 2-PROPERTY OWNERS /AUTHO$I7.�D AGENT' c - m 2.1 .f R..,d Name(Flint) Addr=fu Senvim: O- ri A r a 3mgnateuy Tcicpbm. y ' L.L VWIIQ OIdCeaCOld. Name Print Address far Scrvicc S' T m SECTION 3-CONST LIMON SEBVICBS 3.1 Liconsed Construction Sdpmvisor. - App6O" 0 Lieea>>sea c�rr,�ns : • � RVimfiou Daft T Sipatmue. elepiwo _ r Rood[tome imprveai Com. . .:� .... . Not Applicable 0.. . ... .. _ . .. .. Company Name ft'! Itegat.omq!Numbec Address: _ .. . S' T D z I SECTION 4 WORICM CONQBNSATION. G.L:C.IS2. Mc(b) Workers Compenaa�n Insurance affidavh mirot be ooropkoed+i4d ddb wi16 this applioabliq'FaYtoae to prvvide this affidavit will raealt in the da4isl ofthe isaoeoca of the 6nildnt S�rdti&a&Att.Wd Yes.......CI SECTION S-Des . Work dw& " New Construcfiioo .Ex>stingButldmg;.( Repair(a) ':.01` Alteatims(a) ..❑ . ;Addition .t p .❑ specify Demo � Accessory Bldg Ll lilicm ❑:. Other-. �. Brief Description of Proposed Wbrrlc ,_)301 eft SECTION 6-ESTIMATE CONSTRUCTION COSTS _ Estimated Cost(Dollar)to be' C ,.t pplicsia 1. Building (a) Building Permit Tee... ( S 2 Electrical s + (b) _Estimated Total Cost of... , Cation 6 " 3 Plum ' c, Building Permit fee .►:x rol 4 M�nical 5 Fire.Protwhon.... 6 Total (1+2+344+5), 31 Check Number SECTION 7a-0VVW=AUTHOR17ATION TO BE COBOUTED WHEN OWNERS AGENT O]R CONTRACTOR APPLIES BOR MU DING PERMIT I• _. as OvvrAdAuthotized Agent of subject property Hereby authorize to act on My Behalf,in all matters relative to work authorized by this building permit application. S' of Owner Date SECTION 7b-OWNER/ADTHORIZED AGENT DECLARATION ?res i as OwuedArthoriced Agent of subject property Hereby declare that the statements mrd mfmmation on the foregoing application are true and ac muerte,to the best of my knowledge and belief Punt Name �� S4P9m OfOwwdAgmt Date. NO.OF STORIES SIZE BASEMENT OR SLAB SPLE OF FLOOR T1MBM IsrT f 2 x 3 .c SPAN DII++IENSIONS OF SII L3 DIMENSIONS OF POSTS ' MU NSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNES3 SIZE OF FOOTING. % MATERIAL OF CHIlvIlVEY IS BUILDING ON SOLID OR FMIM LAND 43 IS BUILDING CONNECTED TO NATURAL GAS LII3E (� I I _ . Location �0+a t. �g Art(,u —PI No. LY-3 Date 5--31— 0 Z MaRT� TOWN OF NORTH ANDOVER _ O P • Certificate of Occupancy $ �'�s'•• E<�' Building/Frame Permit Fee $ CHUS Foundation Permit Fee $ /00 Other Permit Fee $ TOTAL $ Check # 33) 114/U 15589 Building Inspector TOWN OF NORTH ANDO' "ER ; BUILDING DEPA,ITM SVT APPL[CATIONTO�`ONBfR MWAMkRZXOVAjrFL.gLD OLISH AONSQBTWOFRMII.YDWBL tG BUlLDlKG`PERMrr NUMlBER_ y3. DAA Issue: = r- o , . . SIGNArM. . �.: -V B . of Date _ SECTION 1-STTE INFORMATION Z 1.1 1'raparty Addrss3' Asse®pra Map and Patod Namba: I. ZQujmslmfamdiao _. . ' 1.4 - .. Duma t1� 1 s r 7 • -.`:Id Arm - • g . 1.6 BURDING SETBACKS Front Yard - Provide Provided per. 3p 2A V Wata aop*MjM.C.ao sd) e naz n rmae o Aisles FbidgAw 0 o. SECTION Z-RROPEIiTY OWNERSHIP/AUTSORI7�6D AOE$fT 2.1 Owpw of 12000rd .. . m Nems Address for service 1 r, Ti tiww ffi Name Print Addmav for SaMw—. O" Z S' r one m SECTION 3-CONSTRUCTION SERVICES QO 3.1 Licensed Construction Upervisa.- ! Not Applicable 0 Lioanud Canwuofi-Supervisor: 1 license Nuoltier 0 - _ CSS 630 a (nW"> C I %C »rte sem. Tdephone W. V > � .. .. pw _ . .. ...,..d.. ... . . NotApphaabte 0 0 Compmry Nemo _ _ , .. _ r Fxpimfion Address: - Dda ^z^ swmdum Tel4` SECTION 4-WORKERS COMkBNSATION. G.L:C-ISZ § 2ic(b) _. .. _ Plotters Compeasation Ihwr meaffidwk j htffbb ¢q FaYlvre t6rovido this affidavit Will rssuh in tbo damal oftheissu mm oftlro _ affidavit Ai M*W 'Yes.......G No... ..IJ SECTION S Des ofProosed.Vflortt(che&aIl " New Construction '. ). mss} :0: :Addition -0 . 0 .. .,:.. . a Accessory Bldg 0 - Demolition ❑:;. :. Other" ❑ specify �v:. Brief Dea iptimiofProposedWivlt SECTION 6-LUI MATED CONSTRVCI30N COSTS hem Fstimated Cost(DolJw)to be" . C hied "t ,licant lig .c IL0 (a) Building Peauwt Fee_ liar 2 Electrical .. _. : ... i t QOt7 (b)_ Estimated Total Cast of Con*wtion . 3 .._Plunibirig _ t ` Building PeYmitfee;(+):?�'(b) 4 Medical AC.. O. 4.a S. _FireProteation..._ 4000. - 6 Total 1+2+3+4+5 f Check Nmmber. SLCPMON 7a-OWNER AUTHORMEATION TO BE COMPLBTED WHEN . OWNERS AGOT.OR.00NTRACTOR API!'- M IZOR BUILDING PBRMIT I• �__ as OwnedAuthorized Agent of subject property Hereby authorize to act an My bebalf in all matters relative to wort authorized by this building permit application. -Signatureof Owner Data . . SEMO(N 76 O MMA--MBpRIZED A6ENT DECLARAnTION� I �r�s i rk as OwnedAudwr zedAgent of subject Property Hereby declare the the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Ownei/Agent . NO.OF STORIES 2 SIZE BASEMENT OR SLAB I SIZE OF FLOOR TDOERS 1 n t0 2 x 3 x f SPAN.. t" DIMENSIONS Of SUS DIMENSIONS OF POSTS DIMENSIONS OF.CTMDERS _.._ HEIGHT TECKNESS SIZE OF F00UNG X MATERIAL OF CHavID1EY L4 BU]LDWG ON SOLID OR FILLED LAND IS BUILDING CONNECM TO NATURAL GAS LIIaE Q i FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ******APPLICANT FILLS OUT THIS SECTION APPLICANT :iekr-i �Y .C �� PHONE_ —00b 1 �� LOCATION: Assessors Map Number PARCEL—) PARCEL_ SUBDIVISION— � r r In 'PI LOT(S) STREET 5�L. '� l FlCC ST. NUMBER__-S ` **********OFFICIAL USE ONLY- RECOMJffi4JDATJ0NS FThm AGENTS: C A I AD IS BATOR DATE APPROVED DATE REJECTED_—____,_— COMMENTS _ TO! N PLANNER DATE APPROVED V DATE REJECTED__ COMMENTS _ _— FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED— ------- SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS — PUBLIC WORKS-SEWERIWATER CONNECTIO Z 4--_v_? DRIVEWAY PERMIT— FIRE DEPARTMENT I RECEIVED BY BUILDING INSPECTOR _— — ---DATE— Revised 9X97 9197Im The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit No ec Coal+ Cyr . Please Print Name: Location: City Phone am a homeowner performing all work myself. F-1I am a sole proprietor and have no one working in any capacity ® I am an employer providing workers'compensation for my employees working on this job. Company name: 1�04 F"Inti( Cap Address 100 114,ray GOO Cily: Nof-�k a/e2 Phone#: R7 0 fo? 6- 7 7 J Y Insurance Co. ,090-11 7yvS �,-,J�tiJtp Policw# l\I(3WC'-.),0"7(34OQ Company name: Address City: Phone#. Insurance Co. Policy# Failure to secure coverage as required under section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the town of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature aQ Qas Q C� �P� t � Date +_ Print name lz•a4s Q C4rro CI Pre icA "A Phone#g"'V bah"I72 Official use only do not write in this area to be completed by city or town officiar ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORMWORiCMAN'S COMPENSAflON GROWTH MANAGEMENT BYLAW EXEMPTION STATENlEN-1 TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This fornl shall be used to assist the Bujlding Deparuncnt in their deternunation of exemption under sccuoll S 7 6 of Lhe Town of North Andover Growth Mallagement Bylaw. The apphcarn shall pros lcc all of tit; necessan informauon as requested below Pernlit rlpphcont Property address ' Mtlp i R11 cc] Applicant's Phone Number Single Family Two Family I the undersigned applicant Ibr the above properly attest than U1c aua,hcd building f),mut for%,h'jl 1111 ,nn uocs.untply with the EKEMPTION section 8.7.6 ofthc Growth 'vl,utugement 13ylaw.I also,rndenu a.tnd pruv!dtngth101111 du.'iw1 absolc c me or any party to this permit tom the requir0ments ol'ubtain ng usher penruts rcqutred prior to the issuance ul'the bu:idiib pernrut. Funher I understand that m,v interpretation of the exemption status is subject to review by did Building Deparuuera and:s ctrl', aili.-,ally accepted when the building pcnTu.i is issued. l 3ased on saxion 8.7.6 of the North Andover Growth Bylaw the above a and the work us applied for on tz above JUL,in Ute bu1!d1r.; Perla 3ppliC3600 and associated aaachments,complies wit11 one or more ul'the fullusving sections ns indicated by a cheek malt 11is is an application for a building permit Ibr the rt largenr 1e r-aoraUUn or roconsu-utacon of a dwel Ing u1 ex,s1 rice ,)(he effect ve date ofthis bylaw,provided that no additional resid sial unit 1s creased. The lou(s)was/were created prior to May 6, 1996 and are exempt from Ute provisions of seaiot 8.7 ol'the Zoning Bs 1.cc This application is for dwelling units for low and or moderate ulcome families or individuals,where all 01'Lhe muc:0r. ul'S 7 o are met and or represents dwelling units for senior residents,whe e occupancy of he inns 15 restrluud to scnlur c11 !.a, trot h a propaly execuled and recorded dead restnaion ruruung with the land.For purposes ofdtls seat on"senior"sllull:;!c:u persons over Ute age of 55. This application is part ol'a development project which vuluntanly agreed to a minimum 40%perntartctu reduutlun tit tie city(buildable lots)below the density pernruacd under zoning and feasible given the orvironmenwl conditions ol'ute trout,with u1: surplus land equal to at least ten buildable acres and permanently designated as open space or farmland.1110 land to be preserved sh l! be protcaed Bom developmem by an Agricultural Preservation Restriction,Conservation Resmaion.dedication to the fuw".01 uu1c: sumllar mechanism approved by the planning board Uhat will ensure its protection. This application represents a tract of land existing and nut held by a Developer in common ownership with an adt,"111. parcel on the effective date of this Sea=8.7 and shall receive a one time exemption from the Planned Grow h Rutz a td Development Scheduling provisions for the purpose of consuuaing one singie family dwelling unit on the parol. This application represents a lot which is ready for a building permit(all other permits from all other boards anti vnun)ssions have been received and the project is in compliance w:ut those pcnruts),and the Development Schedule does 1101 aomrnodate issuing a building pennt in that year.One building permit will be issued per year per Develupmznt until such.:m:.., unc development schedule accommodates issuing building perrruts. Applicant must subnut an approved 1-01:\4 U w101 uus E\EN4PT10N ?LEASE PROVIDE ANY AND ALL[NY-ORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN DE1ERM4NA71ON THAT THIS APPLJCATION IS ALLOWED UNDER ONE OR MORL OF THE ABOVE EXEMPTIO\-� of SIGNING BELOW I ATTEST TO THE ACCURACY OF THE(NF'ORMATION PROVIDED.AND THAT THE i3L'ILDL\G PERvUT IS.-kLLOVED AN E\Etv(?TION AS CITLD,ABOVE. FLRTH-ER I UNDERSTAND THAT THE SUBMITTAL OF M]SLEADING OR INACCURATE INFO RMATIO'v'0it'fl!E CHECY NG OFF OF A ABOVE EXEMTMON WHICH DOES NOT COMPLY,WHETHER DONE TO IyIY KNOWLEDGE 0'1Z NOT IS GROUNDS FOR REFUSAL BY THE BUILDfNG DEPARTMENI'TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE DATE !T01S FORM TO BE ATTACHED TO TIE- BUILDM PERMIT APPLICATION BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 063503 Birthdate: 07/19/1955 Expires: 07119/2003 Tr.no: 12903 Restricted: 00 JAMES V CARROLL 12 PIPERS GLEN ANDOVER, MA 01810 Administrator IIJ:JAI :11�I OJ:_{� �/�1�y �l COTE O 1N$ _ 188VEDa7T ,�VC:. .. 1- PRODVOER THIS OERTIFICATE 19 I8SUEO ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THe CERTIFICATE HOLDER. THI2 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED &Y THE POLICIES BELOW. ROBERTS INS AGCY INC COMPANIES AFFORDING COVERAGE 1-060 OSGI--IOD ST N", ANDOVER MA 01345 OOMPANY i LE„ER a WFSr�RN WORLD RNs CD COMPANY I L48URZO LETTER NANOVER INrSUn_A o_7 CO 1C ANDOVER REALTY �ORp LETTER Y C S LIABILITY -Ap rry_ ... 100 V /"1 , ... -I T .BILI 1V .. OIIl��v'i'CAKE RD GCMFANY N ANDOVER NLA 01845 LETTER C I_UA.RD INS GROUP COMPANY LETTER COVE” _ THIS 16 TO CERTIFY THAT THE POLICIES OF INSURANCF LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T H6-CLIC' PER OL NOIGATED, NOTWITR8TANDING ANY REQUIREMENT, TERM OR CONDITION OF ANv CONTRACT on OTHER DOCUMENT W•TH RESPECT 70 ',v,,irH TH)S CERTI11CATI MAY SE 16$UED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DG$CRISED HEREifV IE R}UBJECT TO AL'_ TMF IEKAS IEXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS BROWN MAY HAVE 6E9N REDUCED BY PAID CLAIMS. CO TYPE OF 1N9URANC! POLICY MUMBLER :PbLICY eF'v6CTIVflPOLIOY EXPIRATION LT* OAT! MMOD(M DATE(MMlOOlYY) I,Wnl oENSRAL LIAbILRY NPP 7 1 0 5 745712752 773755 Ot;NER,+i AOQFlE0.1Te � . . _. CCAIMERCIAL GENERAL LIABILITY PRQDUCTS.COMn;OP.4G C. CLAV1 MADE }{ OCCUR. PERSONAL d AU'Y ',JURY CWN¢R'S d CON''RA0TOR3-ROT. I IaAc;orcunnENce j ..._ _.. ... PRE DAMAU(/Vly One 11,01 0 i) C WED.EXPENSE(Any me porxm) Ii 6K5069646 AUrONOE LIAISILTTY ADN 5 0 6 9 6 4 6 _5/0G/02 2 0 5, 0 3 COMBINFE SINGLE ANY AUTO LIMIT -I Or,� •` ALL OWNED AUTOS 80D LY INJURY - _� 3CHiDULED AUT'OB [Per person) X H:REC AUTOA BODILY INJURY X NON•OWNEO AUTOS (Per"CIdwi GARAGE LIABILITY . '..... I I PROPER'Y DAMAGE g 1 EXCESS UARUM CUP1 D 04 9 4 6 3/r1 3 0 2 � 3/ 1 3 n�3 EACA OCCURRENCE X UMBRELLA RORM AOQRE©ATE g 0"H0 MAY UMBRELLA FORM WORKER'S COLIPeNSATFON NOWC 3 0 7 9 5 8 3 13 0 2 3/13//03 :K STATUTORv LIMI's - AND --- .EACH ACC:DrzNi _ DISEABB-PCIIC)'LIMIT &5o;� �:_ EMPLOYERS'LIABILITY ... ... .OlgegBE-EACH 6MPlCVFE S ri S 0 D OTHER it O 111, tOh OF OPILAATION Qr.ATION&NEFBCLEBBPECIAL ITEWO FA.X; 978-475-')942 I i ; TIFICkTK-900 . . GSN�ELLd'�ION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TH090F, THE ISSUING COMPANY WILL ENDEA`OIR TO MAIL 1-0 DAIS WMITTEN NOTICE TO THE CERTIFICATE HOLDER VAMED TO THE ?OWN 0� NORTI ANDOVERLEFT, CUT FAILURE TO MAIL HUGH NOTICE ALL IMPOSE Nn 03L.GAT0t. C. DUI=DING INSPECTOR UABI ANY')I00D L T­i CG AC EIVTS OR REPRkGEf; ATI L'3 j 27 CHARLES STREET AUTHO Res ATTv NORTH ANDOVER MA 07645 Michael P Roberts p k¢ORPI'2J-S' r80) �J1CORi5 CQRAOAA'IJQN 199C! North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: r►'1 Av A ,�,� 30 Y Ab VJsfrieC- kT- LOF o (Location of Facility) &,�, Q C: .+ Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i YASoheci COtiPLTPQNCE REPORT - Massachusetts Energy Cade Pe=::,t a i V,T,Scheck Software Vers-10n i ite�ease I T _ Pi.A.ti NO. 743 CITY: Plydover 97ATE: Vassach::setts EDD: 6322 Co:,STR:;CT:CV TYPE: : or 2 "3r y, ;Detache.. HEATING SYSTEV TY?=t other iEc^- =eC•riC 8es°sta:i^.e OA E: 3-23-2N! COMPANY !NFOR1`SAT10 BRJNO ASSOC. 28 REERRELEY :TOAD h..ANDOVER, Ma '"81-t CG*:?L:ANCE: Passes Maxir.i SA = 833 yo-jr F._-me = 72B Area or Cavi ty Com:' _:asinc/Door CET: -GS ------------------------------2359-------------------------------------- ------ ------------- - C 64 wAIILS: wood Frame, 2E^ G.C. 36!2 :3 301 SMT: Cone. 8.,+' `J(: V.V' ..nnu,. 7.36% .v -M^ �:,AZItiG: dows dors =E` 35' - q, COORS ;.C3 ,..353 acAC-rQJIP '\T-----_3Ce.-- 'i_u AFL'----------------------------- ------- COMPLIANCE STy_EuEhT. The p-oposed build;no design described `ere is consistent ith "he b-:J1d C Dans, spec'_`_ica .ionS, and .e= ca ::.7=_0•^•s tedwit: 5� 14{ f " TITLE: PLAN NO.743 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2-.01 Release 3 DATE: 3-23-2001 Bldg. { Dept.1 Use I I j CEILINGS: [ ] { 1.. R-30 Comments/Location I WALLS: I 1. Wood Frame, 16" O.C., R-13 Comments/Location I BASEMENT WALLS: ( ] I 1. Conc. 8.0' ht/7.0' bg/8.0' insul, R-19 interior cavity I Comments/Location { WINDOWS AND GLASS DOORS: [ ] { 1. U®value: 0.35 { For windows without labeled U-values, describe features: { # Panes Frame Type Thermal Break? [ Yes [ ] No Comments/Location I . I DOORS: [ ] i 1. U-value: 0.35 { Comments/Location 1 I HVAC EQUIPMENT: [ ] I 1. Furnace, 87.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: ] { Joints, penetrations, and all other such openings in the building 1 envelope that are sources of air leakage must be sealed. When I installed in the building. envelope, recessed lighting fixtures t I shall meet one of the following requirements: { 1. Type IC rated, manufactured with no penetrations between the 1 { inside of the recessed fixture and ceiling cavity and sealed or Basketed to prevent air leakage into the unconditioned space. .; { 2. Type IC rated, in accordance with Standard ASTM E 283, with no I -more than 2.0 cfm (0.944 L/s) air movement from the the { conditioned space to the ceiling cavity. The lighting'-'fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure ` ►' i difference and shall be labeled. I VAPOR RETARDER: t y [ ] I Required on the warm-in-winter side' of all non-vented framed - { ceilings, walls, and floors. I MATERIALS IDENTIFICATION: ] { Materials and equipment must be identified so that compliance can { be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values, glazing U-values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. I I DUCT INSULATION: [ J I Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: [ ] ( All accessible joints, ' seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or y' I joist cavities/spaces used to transport air, shall be sealed t I using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be r I omitted where gaps are less than 1/8 inch. Duct tape is not z I permitted. The HVAC system must provide a means for balancing I air'and water systems. f': I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual i I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or 'floor shall be provided. I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I SWIMMING POOLS: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps- require a time clock. I HVAC PIPING INSULATION: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in. ) : i PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I CIRCULATING HOT WATER SYSTEMS: [ ] I Insulate circulating hot water pipes to the following levels (in.) : PIPE SIZES (in.) I NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F) : RUNOUTS 0-1" i 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 I 1.0 1.5 2.0 I 140-160 0.5 I 0.5 1.0 1.5 I 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- i � T6own o ORTiy Andover No. � y3 y _ ,o � ndover, Mass. dQ T O LAKE COCNICHE WICK � �p 0R4 ATED SACHUS I T FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ---W�� /I/ A*v-dRv;.P......R. .Iro ll d /�......... ....�......,P..................................... has permission to excavate and pour foundation at # c Airr/_v T0� for the purpose of..I.l..RQV#4..3..,hV.8KM.,.3 ...��.. N '.�r....4�1. �.� ... lS�. �t�L.�. The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. 3 S/ ' 4 lSj) f 0000 VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. BLDG. PERMIT F Io � .LESS FDA FE O ..... .......... ............. .. ............................... DUE FRAME PERMIT= • BUILDING INSPECTOR NORT#q Town of over o No. = y y I Ova T �O LA0 dover, Mass., 3 a GOC WC. WICK ADRATED S H E BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT.N...r.�.�!.....Avalo-a-ler......,�� 0)./� ......... BUILDING INSPECTOR o �.. .... p► ... .. ............... .. .. Foundation has permission to erect................ .... ................ buildings n.)Pial-4#4 ......1814 .:('l..!V ON.... �Ae�C Rough to be occupied as j j.Q!oMj 3' /i�....13 / J-� 11�..V r..�?.�N . _. ...... !lrL�. �/VG�.► Chimney . .. ............... provided that the person accepting this permit shall in every respect conform to the to .. of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to a Inspection, Alteration and Construction iof n Buildings in the Town of North Andover. 3� TZ/ I 4 a O '4 OMEMO PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS. ELECTRICAL INSPECTOR C 000" Rough .................A................................./....'.......................,............ 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. SEE REVERSE SIDE J1 Smoke Det. R 1 - -184— / ,�82 384.88' AIL � fes — �/�-- REQUIRED ZONING SETBACK 21NE4TYP- I —53 / —182 �41 /' 11 al LOT jL2 _ AREA = 114,385 SF ��� \ \ � � D 52 AIL UY 00 \ D-51 EDGE OF WETLANDS SEDIMENTATION CONTROL J — LIMIT OF 100' r BUFFER ZONE' 0) —� \ —194—, 11 1 l 5 .00 ' 9 ` LO _ / , ••' I 150' OFFSET / FROM WETLANDS — 195.0 j TOP F►�ID. — 194.5 GAR. 4R• \ SEWER— SERVICE , SCREEN 19 PORCH LOT LEACHING CHAMBE ,oav \r9?— TEST ° PIT Z ZONING DISTRICT: R 1 Y:�-- MIN. LOT AREA = 87,120 S.F. cLEANOUT / 1 go-- MIN. LOT FRONTAGE = 175 FT. MIN. FRONT SETBACK = 30 FT. / MIN. SIDE SETBACK = 30 FT. LOT 1 �� 1 / Z MIN. REAR SETBACK = 30 FT. 19 � � 19 C�NOUT—� / 'SEWER STUB {9� INV= 18 / �Z F Md s 9 P G. cyG H IS11ANSEN I / 5MH 7 o CIVIL y No..28895 FSS/DNAL 1 J�Oq bio PROPOSED SITE PLAN ' FCAiAF'o OR L 0 T 2 BERRING TON PLACE IN NORTH ANDOVER, MASS. PREPARED FOR. CHRISTIANSEN (j,SERGI PROLANDIOSURVEYORSERS JAMES CARROLL 160 SUMMER ST. HAVERHILL, MA 01830 TEL 978-373-0310 © SCALE. I " = 40' DATE: MAY 23, 2002 2002 BY CHRISTIANSEN & SERGI, INC. DWG: N0. 01.039007 Location Jz""' — �rip No. l0 (13 C Date 17-20- O-Z Of NORTH TOWN OF NORTH ANDOVER .. o .•1,x•0 f p Certificate of Occupancy $ �1SSACMUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 30 �� p(Ace TOTAL $ 30 Check # ` 15740 Building Inspector o Town of North Andover ,,aRrN Office of the Building Department o • ' Community Development and Services Division _ William J. Scott, Division Director 27 Charles Street North Andover,Massachusetts 01845 Telephone D. Robert Nicetta pone(978)688-9545 978 Building Commissioner Fax ( )688-9542 CHIMNEY APPLICATION AND PERMIT DATEy�6\ 30., 7_Q'-� PERMIT LOCATION 6li ?)aA A .,A,3��N OWNER'S BUILDER'S NAMEkr-). �D MASON'S NAME ru)V onC ff- IL MASON'S ADDRESS �-O . V--E)X 'Bo Ucs MASON'S TELEPHONE MATERIAL OF CHIMNEY Zv) JC . L\0C 1g INTERIOR CHIMNEY EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES_ 7 9 x V;;b THICKNESS OF HEARTH_? 0 Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: v SIGNATURE OF MASON o ��s��� Cn�c �� j CONTR. LIC. # EST. CONSTRUCTION COST/CONTRACT PRICE PERMIT GRANTED 17-3o - 0 -3- FEE p , ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 638-9541 BUILDWG 6 t8-9545 CONSERVATION 688-9530 HEALTH688-9540 PLANNING 688-9535 Location No. Date �-- NORTH TOWN OF NORTH ANDOVER 3 � - - OL f - A Certificate of Occupancy $ o �i7s'•'°'t�� Building/Frame Permit Fee $ a b y d sAG14 Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ 67v V0 Check # 3 Qq I lfmfa��, 15616 Building Inspector JUN-10-2002 MON 0331 PM 5RISTIANSEN 8 SERGI 1 978 372 3960 P: 01 EXISTING FOUNDATION T.Q.F. EL = IMP w 0� LCAT 2 w w M1CIdA J. µ 11 s� N BERRINGTUN PLACE FOd1NDAT/ON '�"� r�Mr W A`'� SfMWW SWWI °�`� M T►VF Iffina Nra srm4 ll AEgre�rMim ar w LOW LOCA WN PLAN � °' -- r n=nn 81M.M A8 GpMF7161AQ� aftm aP fX mwne rj CLIENT: JIM CARROLL 00 WA*W stats Wr ae U=W r ar ClJEMf FM 4xr PURPME 01W IW Mr UMMO AWMEMM MSN Tw MIS CERTIMATION IS AMAC AND LIMM OWUM PMMMW aP WWWMAMW*MW W— AxtmmiwIb ] A90V� CLIENT. ?wAupw is Tw captWom PAra+cm Gli ddNaMOD A SERGI ALG Am AW Lmar11 mm LIRE fWWLOCA77OM. LOT 2 6ERRINOTOM PLACE �or or mrae' iwwa acv '� MMM COMMMm Trews. �lrlRTH ANDOVER, MA. SCALE: 1" = 60' DATE: 0617102 y CHRISTIANSEN &SERGI "' U }�WOKO Sr NAAVkAOrUJK aim ML ipm-ass-adfa c zw sv aftsy mum t �tyaoV MAS aI1GiNMR a103a0a5 t opoR,«,ti 0 O A y,Ss4cnKE~� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 6 y13 Date THIS CERTIFIES THAT THE BUILDING LOCATED ON ©J02 34 /11,v!?T 0 AJ /7 f c C 1j /j Raoth 5 MAY BE OCCUPIED AS 51 A) /e--?:a/h3`/- BA t65 utiZ) IN ACCORDANCE WITH THE PROVISIONS OF THE MASSAtHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY //APPLY. CERTIFICATE ISSUED TO /�/D A9 4lyQ clyek 1�ed lly (ell � �e o J-0 AN41yC.4,Ve_ 3 `f / Building Inspector NORTH Town of 4 , Andover No. o �` dower, Mass., 3l o� 0,06? COG KICM WICK �.9 A�R'STEo PPa��S S H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.�.i�pr ..... 4-cio-a-er .A 0).l.��.........el 01.�.......... oundatio �C�BUILD..... .tet / Foundation n�� has permission to erect...............�.... ................ buildings n.�07 .. .....,�!Q/'/'!�N O /AC's Rough��j�� to be occupied as!�. 1M�3 /.' ..1�? 'I� all..0r.. .!!VIts Nt......K.lS.I .!PC!e. Chimney P _ provided that the person accepting this permit shall in every respect conform to the toof theapplication on file in Final this office, and to the provisions of the Codes and By-Laws relating to tie Inspection, Alteration and Construction of Buildings in the Town of North Andover. X7 13/ 1 ( �j a 0 &140 O PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. `'r 151,� PERMIT EXPIRES IN 6 MONTHS a l L \ ECTRIC INS UNLESS CONSTRUCTION/) ST TS �U / [.... ...................... 1 C ........ ��13 BUILDING INSPECTOR r Occupancy Permit Required to Occupy Building GA1NSftCT6R �v u Display in a Conspicuous Place on the Premises — Do Not Remove o ,11-0, No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspect. Burner t),/-\ Street No. (a SEE REVERSE SIDE Smoke Det. Town of North Andover o� �,OFtTM q Building Department 3? gt� 4eo ;d'e�,0 27 Charles Street o -= North Andover, Massachusetts 01845 �. (978) 688-9545 Fax (978) 688-9542 o �-0[oc HIwHH y1' 'T3 List APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS 5q Be r r t✓1!5,to h P Iyk(/ Q LOT NUMBER SUBDIVISION &f r in !�Io o {rji9C.e DATE REQUEST FILED I S 0 a DATE READY FOR INSPECTION 1! 1.5 Q 0 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVATION DATEX��( PLANNING DATE 07- D.P. ZD.P.W. —WATER METER _ ATE �,�� D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED A&/D ECTION REQUEST DATE. AUTHORIZATIO 3 Ci J Date.....11?. ��d '� NORTM TOWN OF NORTH ANDOVER 3? . OL PERMIT FOR WIRING ,SS^CHUS� This certifies that .........� !.....Q '.��.U.�...�. U........................................... has permission to perform ` wiring in the building of...... .... . �...il v//.....Q of S/................ . ( G ' at.. C�. .....(. ...... .... ......... orth Andover, ( � )) Fee.,1..V...:.(,kJ.. Lic.No.�-..t..... ............... .:.�_.f:.+....)�,�, .. ......... LECTRICALINs ECTOR Check # �' U / Official Use Only Permit No. -X�5�2tn2a!!$ 1'7�f tY� S.Sr� ZtS�7'IS �e�ra rnreat oa aitBltc Sa 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 e (Please Print in ink or type all information) Date—i::! L 02-. To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number 7R)Lrraal J 6 l):J bA O Owner or Tenant ��i2R l nC�,� 'T)2 Q Cf 1-i" Owners Address Is this permit in conjunction with a building permit Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building -rA:79)P 5egVic Utility Authorization No. O FcP 1f 0 Existing Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters Ndw Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Lciation and Nature of Proposed Electrical Work aV T�/o Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units I No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.0 Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW DetectiordSoundirig Devices ❑ Municipal ❑ Other 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 = M you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME D LIC.NO. Lkensee 45M Signature / LIC.NO. .�1 al Z TelNo. Address ,SU Tel.No. 6' OWNER'S INSURANCE WAI.ER: I am aware that the Licenses oes 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) S Telephone No. _PERMIT"fEE $ " (Signature of Owner or Agent) Date. Of ,FORTH q� 6 TOWN OF NORTH ANDOVER f P ' PERMIT FOR GAS INSTALLATION 9 - �� SSACMUSE This certifies that . .�/??�<I �? �,'� l has permission for gas installation . . . . .. in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . at �-; North Andover, Mass. Fee. ,4.`: . . . Lic. No.1/ _ . . . . U GASINSPECTO Check# 4174 MASSACHUSETTS UNIMRM APPUCATON FOR PERMIT TO DO GAS FTMNG (Type or print) Date �- NORTH ANDOVER,MASSACHUSETTS Building Locations LOT al �L �,'`� +�scF1 2�rJ��Ua OI A c Permk# '117 V Amount$ - lh G Owner's Name ► New El Renovation ❑ Replacement ❑ Plans Submitted ❑ W 0 � PQ A SUB-BASEMENT BASEMENT I 1 1ST. FLOOR ( . 2ND. FLOOR 2 1 3RD. FLOOR 4TH. FLOOR STH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print of type) Chmk one: Certificate Installing Company Name �k�is2a[.A� Corp. Address ��33 �n�rar �-�-�' ❑ Partner. Business TelephoneG.-��,Gj 7_� E] Firm/Co. ` Name of Licensed Plumber or Gas Fitter ISL 10— INSURANCE wINSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes El No❑ If you have checked M.please indicate the type coverage by checking the appropriate box 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 Chaptr 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one.- Signature ne:Signature of Owner or Owner's Agent 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=Gasle d under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber 1 l 3 S S City/Town ❑ Gas Fitter License Number ® Master APPROVED(OFFICE USE ONLY) ❑ Journeyman I Date R1,14 Of �c TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING SACHUS This certifies that . . . . . . . . . . . . . has permission to perform . .✓.; . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . ....:�c..,�:'�� ���!. . . r�•--?- . . . . at North Andover, Mass. Fee��y `. .Lic. No.J� -5,1.`.f lV . . . . . . . . . . . { PLUM811f1 SPECTOR Check # �S 5403 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Locationl a?2 X59 �R.2Aa P4 Owners Name CA-a" 1 �,J S}-- Permit# Amount Type of Occupancy &z% New R1 Renovation Replacement E] Plans Submitted Yes No FIXTURES J. Q F F a CC Q � z w x x m a H w w S�I�IC ISE FLOOR 12 1l I m mm 3 5 3 l 3MHDM 4M Hj0CR 5M FLOQ2 6IH FI�t 7IH FI M 8TH FIDM -H--:�--9��7-P-4�-- . - 1 (Print or type) Check one: Certificate iInstalling Company Nameame(&t� O'umb.aC cn'�4-uCk)✓S ❑ Corp. Address 1 033 "0- ou 11- b ❑ Partner. �Busmess Telep one Cj gy,q.�'1_'?8 Ott Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy rxi 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 r'Al 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 Plumbing C de and Chapter 142 of the General Laws. By: 'Signature o rcensea riumoer Title Type of Plumbing License � City/Town _k+ 355 ID um er Master Journeyman APPROVED(OFFICE USE ONLY Date. . . 40RTM TOWN OF NORTH ANDOVER f 1 a PERMIT FOR PLUMBING • o � 1 ,SSACMUSE� M This certifies that . . ����✓N^w v {� �f r �. has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .K a N. . . . . . . . . . . . . . . . . . . . . . . . . . . '. . c . "'. . .... .. . .. , North Andover, Mass. Fee. .c '57. .Lic. c PLUMBING INSPECTOR Check # 7 0 5689 i i ► : > MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Dh Date Building Locations �It.�+Nilo I' Permit # Amount Owner's Name —•� ��`P t\ New Renovation Replacement Plans Submitted a 1 1 FIXTURES wrfrk Cr rA o, H a EN UIt SCSBM &��lY1EM' LSE FLIDCR M R m 3M RfM 4M It" 5M RfM 6M ROCIR 7M ROM M FLDM (Print or type) ,j., ' Check one: Certificate Installing Company Name t l 1:1 Corp. 'Olt Address S Y` OJ' E] Partner. Business Telephone Firm/Co. Nameof Licensed Plumber: 1`b�y Insurance Coverage: Indicate the tyKof insurance coverage by checking the appropriate box: ❑ Liability insurance policy Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been mlde�aware that the licensee of this application does not have any one of the above three insurance + Signature k Owner ET' 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 unde Penn it Issued for this application will be in compliance with all pertinent provisions of the Massac set4s S lumb' C e and Chapter 142 of the General Laws. By: signature ol Mansea Type of Plumbing License Title City/Town License Murriver Master Joumeyman 0 APPROVED(OFFICE USE ONLY