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HomeMy WebLinkAboutMiscellaneous - 59 CRANBERRY LANE 4/30/2018 59 CRANBERRY LANE ` 210/059.0-0072-0000.0 Address .,J,l c2AM&� � r/ Title of File P.age of Date File Open: Date F e closed: Doc Document/Action Title Date of action fefet to other Purpose of 17ocumE tin JAct of nand nates Document/ document/ Num. Action -- Department ------------ ------------- Board of Appeals — Board of Heal h=PlannBoard ; 9. Conseruatiion 7C�ommlssio ���.dn DEpartrnen,t --I PATRICK J. DONOVAN ASSOCIATES, INC. "CLAIM AND LOSS ADJUSTMENTS" P.O. Box 110 Wakefield, MA 01880 (617) 245-5540 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS. CHP. 139, SEC. 3B TO: Building Commissioner or Inspector of Buildings City or Town Hall RE: Insured: 'upa Property Address: q Policy Number: IWIS 7717 Loss Type: llda Date of Loss: Our File Number: Claim has been made involving loss, damage or destruction of the above- captioned property, which may either exceed $1, 000 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention o the writer and include a reference to the captioned Insured, locatio , po icy number, date of loss and file number. A u r Don n Associates, Inc. Wak ield, MA L% C� On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. FORM U TOWN OF NORTH ANDOVER LOT RELEASE FOlu-1 SUBDIVISION �'RAtilF3�/I2y CAv� ASSESSORS NAP 4-51 SUBDIVISION LOT(S) # — C2AN biz LAnrF PERMANENT ADDRESS (ASSIGNED BY D.P: . ) 5q STREET 59 t C2A1,J 8 E4 R L•tv E APPLICANT .sc,AKI �, CAhlrcL PHONE 683-:383y DATE OF APPLICATION d 1 NA2c►s 5 TOWN USE BELOW 'i'tilS L1HE PLAN NG BOARD ✓ �L ( � . DA'1'I-. APP10VED TOWN 'PLANNER v DATE REJECTED CONSERVATION COMMISSION 41' �y� 9 ATE, APPROVED CONSERVATION ADMIN. F-' ,' DATE REJECTED BOARD OF,HCALT11 i00, / DATE APPROVED 3 A/) j1EALTH SANITAR A DATE REJECTED DEPARTMENT OF VUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS FIRE DEPT.-AU EiR6 / RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Ileal.th Boards, Hie Conservation Commission prier to the I.-m :inc•e of any bulldtng permits for. the subject lot. This form shall not rel.e.ive the applicant from the. compliance of any applicable 'Town requirement or Bylaw. 1 . ' Date....1.Q A.!.q.......... ' p10RTF/ TOWN OF NORTH ANDOVER . n PERMIT FOR WIRING `4`QACMUS� This certifies that . J ... ............ ......................... .....�P ...... . �-{ has permission to perform ... oLf1�.��c Q .......�....-=......�....1:............................... .`�.. ~....................................................... wiring in the building of............."A.. 2 P LN, ort Andover,Mass. ��...... ......1CR......................................' . fie..:.............' '.......Lic.Nox.�... I BLEdTRICAL INSPECTOR Check# C Date.... d� //� ... i0CC o�NonTo, TOWN OF NORTH ANDOVER 3��1 �� •� OCL PERMIT FOR PLUMBING $8�cau5�s f � //4- This certifies that.....................................................t......r....N.......................................... has permission to perform.............. .c..Y P/... .. .............................. plumbin -iy the buildings of.... ......................................................................................... .�i(�G� � C� . r . at..................................................... ......................................., North Andover, Mass. Fee.>�-�...-....Lic. No. .....����1 g / ....�! ........................................................... PLUMBING INSPECTOR Check# /&/0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK k � - . CITY _ I MA DATE E1 / 1 ( PERMIT# h b67 t 5) JOBSITE ADDRESS rD,n OWNER'S NAME��� __�iA�j POWNER ADDRESS TEL - ( FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Q RESIDENTIAL' PRINT CLEARLY NEW: 01 RENOVATION:L2"- REPLACEMENT: 0 PLANS SUBMITTED: YES01 NOR FIXTURES-1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM f --jI __I DEDICATED GREASE SYSTEM _ __._._1 J I I DEDICATED GRAY WATER SYSTEM I �( f ! _ 1 ( ( _._.._. _ ! -Ji I DEDICATED WATER RECYCLE SYSTEM Lf DISHWASHER DRINKING FOUNTAIN __ I I _I __._____-! ._____! _f ._--_ J ___...._I ,� ---_..Vj ..._.,.._j --- ._. i _..__A FOOD DISPOSER EE -.- _.f __.___.J. __.__.__I ___. _.1 I .____j ___ .I _ __I .._.J ..-_ __I ......__I I FLOOR/AREA DRAIN ____1 __? __._J _.__- I _...___j INTERCEPTOR(INTERIOR) I ____._f ____._I i ------- ! _._i _.___j _ i _ _ _..__ j .__. I I KITCHEN SINK LAVATORY _I ( _ _-j j �f J I . l ..__..JI __--...1 f 1, _-- ROOF DRAIN SHOWER STALL I .—_� _... __J _—.-1 ___j j -.__I j -...-._._1 ___..IA--j _ c5RVICE/MOP SINK TOILET URINAL f ..._.__! I _-- f J _ _6 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: p have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY' OTHER TYPE OF INDEMNITY 01 BOND Q 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 R AGENT IDI 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 he (Massachusetts State Plumbing Code and Chapter 1142—of the General Laws. PLUMBER'S NAME wrprLLa ��LICENSE# 50111 t SI ATURE IMP EI ipe— CORPORATION FJ# PARTNERSHIPQ# LLC ( COMPANY NAME[ m5 y d I�� I ADDRESS CITY Te _ - I STATE ' ZIP O ! b 2 TEL FAX LCELL�'�� EMAIL ROUGH PLUMBING INSPE TION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES i q t The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Uf www.mass gov1dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /')')5 U`n 149 cz Address: City/State/Zip:IV, Lej Phone#: 7,Fi^141 -D J_,1� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and I 6. F1 Now construction employees(full and/or part-time).* have hired the sub-contractors 2.[91am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. El Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.�lumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.0Roof repairs insurance required.]i employees.[No workers' comp.insurance required.] ME]Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I-Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. / '✓lev C ��4'U I� �Q Policy#or Self--ins.Lic.#: Expiration Date: / Job Site Address: City/State/Zip: /� L�jo(��v-f ✓».4 . Attach a copy of the workers'compensatioepolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. 2-do hereby cert utid r the pains and penalties of per that the information provided above is true and correct. Signature: Date: Phone#: a- Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: P. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Gonuonwealth.of Massac -asetls Department of lndustdal.Accidents Offlee of InVestigatlons 600 Washington.Sheet Boston,MA 02111 TQ1,#617-727-4900 at 406 or 1-8777MASSAFE Revised 5-26-05 Fay#617"727-7749 www.znass,gov/dia OIVI ( NWEAL ` i O MASS'1 l3SETTS *` PLUMBERS A17 "GASP I TTEI ISSUES THE FOLLOWf1�1G' L I CENSE 1 LIC£<11SE13 kS A JOURNEMANr,�{) a I � 4 � I Lk.... E J CREHA'N ,z E ' fy s:. Ilt 5s5 6 MEAO.��IGLf;N u IV{BiLLERICk MA 01862- 220* } 05/01 f 1`a 2 2 " Commonwealth of Massachusetts Official Use Only o Department of Fire Services Permit No. ?�bZ� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC)/527 CIAR 12.00 (PLEASE PRINT IN NK OR TYPE ALL) FORMATION) Date: �� City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Sf Com/! /,Y lg�G Owner or Tenant jo-- OG O Telephone No. Owner's Address Is this permit in conjunlion wi h a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �h Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires q No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In o.o mergency ig ting rnd. ❑ rnd. F, Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ..... '* ' "*I.."""". ' """""" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water Nof No.of No.of Devices or Equivalent o. Heaters KW Signs Ballasts Data Wiring: n 1 No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HTelecommunications Wiring:P No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. y Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under thepalns and pe alties of erjury,that the information on this application is true and complete. FIRM NAME: . �n ' sJ7,4: LIC.NO.: Licensee: c�Os Signature LIC.NO.: (If applicable, ter_ "exempt"in the icens nz�mber line. Bus.Tel.No. Address: v Lr /' ®� ' � 6'y Alt.Tel.No.• *Per M.G.L c. 147,s.57-61,security work requires Department tic Safety"S"License: Lic.No.• OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. MERMIT FEE.$ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the 4 permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ C r Inspectors Comments: f r Inspectors Signature: V Dat FINAL INS E ION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Co ents: 2 r / Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 4 The Commonwealth of Massachusetts , - Department of'I-ndustr!a1 Acc1d&ts Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/ctia Workers'Compensation lumance gday :BupdersfContractorsfFIectriciauslpliimbers A pplieanl Information Please Print LeibXy Name(Business/Organization&) lividual): S46,y, Address:_ City/State/Zip:Agg�!tX Phone Areyou an employer?Check the appropriate box: Type of project(required): :1 i am a employer with .L� 4. ❑ I am.a general contractor and I ` 6. ❑New construction employees(full and/or part-time).* have Hired the sub-contractors 2. I am a solo proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and`have no-employees These sub-contractors have 8. [(Demolition worldng forme in any capacity. workers'comp.insurance. y. 0 Building addition [No workers' comp.insurance 5. ❑ We axe a corporation and its required.] officers have exercised.their 10.�Electrical repairs or additions 3.El am a homeowner doing all work right of exemption per MGL 11.[(Plumbing repairs or additions myself.Vo workers'comp. c.152,§1(4),andwehaveno 12.❑Roofrepairs insurance required.)i employees.[No workers' 1311Other comp.insurance required.] xAny applicant that checks box#1 must also fill out the section below showingtheir workers'compensa6onpolicy information. I Homeowners who submitthis affidavit indicating they�e doing allwork and then hire outside contractors must submit a new affidavit indicating such. TContractors that chekthis box must attached m additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X am are employer that is,providing workers'compensation insurance for my employees Below is the policy ar�d job site information. Insurance Company Name J / Policy#or S el£ins.Lic.#: Mc " 3yo—-?O/ftq�".Za>y Expiration Date: L /y lS Job Site Address, � )City/state/2ip:, Attach a copy of tete workers'compensation•polley declaration page(showing the policy.number and expiration date). Failure to secure coverage as requireduader Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as wallas civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. Mo hereby cert er pain o,f per,/ury that the information provided above is true and correct. Signature: Date: Q L� Phone#• 4ef: Official use on1y. .Do not write in this area,to be completed by city or tort official. City or Town: Permit/License# Issuing Authority circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Pers on: Phone#: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,. express orimplied,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 ofa•deceased employer,or the receiver or trdstee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having notmore 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 employes." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or rcenewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapterhave beenpresentedta 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 certifcate(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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. he affidavit should b e returned to the city or town that the application for the permit or license is being requested,not the Deprartment of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain.a Workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete andprinted Iegibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be-sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations is (city or town)".A:copy of the affidavit that has been officially stamp ed or marked by the city or town maybe provided to the applicant as woof that a valid affidavit-ii on file for future permits or licenses. .A.new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone a`nd fax number: The Cozx oa��a1Ax of Mmaahmotbs Department ofIndu$1Aria1.A eldents (aloe offAwstigAmm 690 Washiogm Sfroet Boston,MA 02111. T01,# 61.M27,4900 o7d 406 ox 1-8,777 UNSS.F'F Revised 5-26-05 Fax 617-727-7749 wwwnampvfdla. i i COMMONWEALTH OF MASSAHUSE7`T5 ° ® ° " • BQAFfD`0IF: ELECTRICIANS I ISSUES THE FOLLOWING INCENSE AS.A REIa JOURNEYMAN. ELE TRIC JOS A SP I NALE Z 6 P� � y I 28 T URNER DR i NORTH`REA:DIMG L::.!'IA 01864-24'4 I 38463 0'7/31/16 44948 OMMONWEALTH.OF MASSACHUSETTS:: ' BOARD OF ELE<CTRICIANS ISSUES "iHF LICAS .FOLLOWING ENSE :.:;..A: .;k � j: REGISTERED MASTER, ELECTRICI'A : S1?INALE ELECTRIC.- INC . JOSEPH.A SP1„NAVE sem. 28 TURNER Dk AN s ldtlRTH READ I NG MA 01864 2441' 17486 A o7/3�/16 ; 44949 1� s2-e,.-ar2cam- ��// 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be-deemed-by.the,Inspector_ofWires abandoned.and.invalid.ifhe—. ._ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. a ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. Aule 8—Permit/Date Closed: * *Note:Reapply for new permit ❑Permit Extension Act—Permit/Date Closed: Date...... y pORT1, TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUS� This certifies that .................A-b has permission to perform .................v........`.�'.�-.� ..... .. 1....... . wiring in the building of.............. 4f ,1.. ................................. at....... ................. !�..1............ .. ,No4, Andover,Mass. b_ ° Fee.....T...5�...... Lic.No... y5........................... ��..... � S' .Q ELECTRI AL INSPECTOR Check n 3S3y�� `► 0819 ' I_oPJ=ivf/eaa4 of !//addacYtu6etC6 UIECIal u�sa only Permit No. c-. • <�e�arl`rnnn�o�.s re Jervi�e9 -^ J; - BO Occupancy and Fee Checked 1 u ARD OF FIRE PREVENTION REGULATIONS [[Rev. 1/U7 j (leave blank) APPLICATION rt--QR PERMIT TO PERFORM ELECTRICAL RICAL WO All work to be performed in accordance viith the Massachusetts Electrical Code(MEC),527 12,00 (PLEASEPRINTININK'OR TYPE ALLMFOR 11&4 HON) Date: City or 'own of: & ro ,, By this application the undersigned gives of his r h�intention to perform herelectrical work describedlbelow. Location. (Street&Number) Owner'or Tenant ,'G� � Telephone No. V- (—f- Owner's Address Is this permit in conjunction with a 6ullding.permit? Wes ❑ • No [` ( :heck Appropriate Box) Purpose of ISuiIding Utility Authorization No, Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service .Amps / Volts Overhead❑ •Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: a Completion of the followin-!able may be.waived by the.Inspector of FF11res. No, of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans N0•of Total Transformers X17A No.of Lurminaire Outlets No, of Hot Tubs Generators XVA No. of Luminaires Stlimrning Pool Above ❑ In ❑ a.�z,mergency rg�ng rnd. rnd. Batte Units No.of Receptacle Outlets No,of Oil Burners FIFE ALARMS No of Zones No.of'Switches No.of Gas Burners No, of Detection arzd ---- Initiating Devices No.of Ranges No of Air Corld. 'Pons! No.of Alerting D evices r No.of Waste Disposers IaeatPump IYizrizber Pons KtN No.Uf�Seif-Contained Totals: Deiestion/AIer'tin-Devices _ No.of Dishwashers Space/Area kleating KWLocal❑ 1�tnzlcipal ❑ Other _ r No. No.of Dryers Heating Appliances ICW Security Sysfem,s:Y No. of Nater I"do.or Devices or Equivalent of No.of Beaters KW Signs Ballasts Data Wiring: No. of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors 'Total HP Telecommuni OTHER: cations Wiring: �/ — No.of Devices or Equivalent 7"�a 3 Attach additional detail if desired, or as required by the Inspector c f F•oires. -� Estimated Value of Electrical Work: _ (When required by municipal policy.) . Work-to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERA E: Unless waived by the ov rner,no permit for the performance of electrical work mayissue unless the licensee provides proof of Iiability insurance including"completed operation"coverage or its substantial equivalent, The, undersigned cbrtifies that such coverage is in force,and has exhibited proof of same to the permit issuing office, CHECK ONE: INSURANCE [A BOND ❑ OTHER ❑ (Specify:) I cert, cruder the pains and penaftles ofperjury,.that the in orrnatior�on this application is true and complete. FIRM NAME; �-DT �e_Cs�t om-' e L c LIC.NO, V51 Licensee: Signatu y LIC.NO_ {If applicable,enter"exem t"in the license nuntbeF(06. { Bus,Tel.No. Address: _ 1 C,t t v i[e_ d�r _t:RY_ l4 l��c,�,}I( U,3o *For M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: AltLiec,No, Do 91s,3 OVINTER'S!NSURANC'E WAIVER:, I am aware that the Licensee does not have the liability insurance coverage normally required by la1=i. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner_ []owner's anent. Owner/Agent Signature _ TelephoneNo. fE.Rl..�``1 FEE: �_�� REGISTERED SYSTEM CONTRACTOR:. ''—'•;• = IS$UESlIABOVELICENScT0 IE :.;;dT;'SECURT7-Y SERVICES•, -SR ..MARK A :�RoPIIY ... .'4.1•0;::u'N11%I_RSI fY.-AVE -AESTW,.QOI7 _ • M,4�:.U 2.0 9 o-2sx.J..:'Yi<- r4 _•; - G5 C' 07/31/7:3 :849J.7�:.::�..' f,;.'.`C• - •+'F'old.lAnnDaUrhalang,ApP�ror�donx .'i Keep top for receipt and change of address notification. d DP,S Al 0 SIJ-10.09 ✓,/ze•�»ar�wxu�eal�.c�il/Lra,>vu�.a:eC� s2x DEPARTMENT OF PUBLIC SAFETY S-License Number."SS CO 000953 •� - - Expir�es':�02107/2013 Tr.no: 195.0 � S-License: ADT , MARKA BROPHYSR' '410 UNIVERSITY AVE WESTINOOD, IJIA 02090 DIG SAFE CALL CENTER: (888)344-7233, Commissioner Date....=.q ©.7.... 0 NORTH "° TOWN OF NORTH ANDOVER OL O p PERMIT FOR WIRING c �,SS�GMUSE� This certifies that .......oLL/JG ".� ....... .:....................................... ...... . .. ........ owy % has permission to perform ........ 1R............................. ..........t. ................ wiring in the building of LEr� 'p� ...........t.......... ��v.................................. at...........5...f... + ? .......G�...... ,North Andover,Mass. Fee..!-�.5"�'....a.... Lic.No. 16.3. .................... .. NSP E CTRICAL IEC rOr� Check # �© o� 7435 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]1/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with.the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT/N INK OR TYPE ALL INFORMATION) Date: S12,110--7 City or Town of: &(� -6Ka&tQ� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) 59 CV-CAr,6(?,rVt (apl e Owner or Tenant T hi f F-0-u be-14, keej�an Telephone No. 913 7Ltg7 Owner's Address �— Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing ServiceAmps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: IN6l<c'k)N D C'C)CUL. j (GN ID PV L t C-1 r TL T E(-�� puMr Comletion o the nllnwin fable m he waived b the Inspector of Wirer. No. of Recessed Fixtures No,of Ceil.-Susp.( addle)Fans ° ° otal Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA r o. o m No.of Lighting Fixtures Swimming Pool rnd.ove E] in- rnd. F] ergencyigng Battery Units y No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No, of Gas Burners No. o Detection and lnitiatin Devices No.of Ranges No. of Air Cond. Tons No. of Alerting Devices No.of Waste Disposers I Heat Pumpumber Tons . KW No. o el- ontained Totals: Detectioni/Aulerntin2 Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municrpal El Other Connection No.of Dryers Heating Appliances KW ecunty ' ystems: No. of WaterNo. No.of Devices or E uivalent Heaters KW o Si ns Ballasts or Data Wiring: No.of'Devices or Equivalent No.Hydromassage Bathtubs No.of MotorsTotal HP Telecommunications Wtrtng: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wirer. INSURANCE COVERAGE: Unless waived by the owner,no permit for the.performance of electrical work may issue unless the licensee provides proof of liability,insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such c e•age is in force,and has exhibited proof of same to the permit issuing office. as CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify.) Estimated Value of Electrical Work: (Expiration Date) (When required by municipal policy..) ! Work to Stan: Inspections to be requested in.accordance with MEC Rule 10,and upon completion. I certify,under the pains acrd penalties of perjury,that the information on this application is true and complete. FIRM NAME: //' _ LIC. NO.: C/ Licensee: y) r/y' >M U r _ f=� / / Signature / (lfapplicabl rater "ex t"i the license number lure.)`= 1C. NO.: 6 Address: J Ox (,t 4�Bus. Tel: No.: cl ,Z -YS q Tel. NO.: y77. 9YG4/ OWNER'S INSURANCE WAIVER: 1 am aware that the,Licensee does not have the liability i & urance coverage normally required by law. By my signature below; 1 hereby,waive this requirement: I am the(check one)❑ owner ❑owner's a gent. Owner/Agent � Signature Telephone No. PER/YIIT PEE:'$ , ' pd��o C)k, T7 - 1 �- 'a7 PNl F�� mac. Location .` ' r % ' C' r rr':. t No. = Date MORTq TOWN OF NORTH ANDOVER pt,,,IID a Certificate of Occupancy $ f� 99 Building/Frame Permit Fee $ r.3� �ss� CMU,Et Foundation Permit Fee $ 1 Other Permit Fee $ Sewer Connection Fee $ � ,„Water Connection Fee $ i 7- :1 '"TOTAL ' Building Inspector Div. Public Works X., Location No. /1 7�' / f�-... Date I 40RT" TOWN OF NORTH ANDOVER C� O0A Certificate of Occupancy $ Building/Frame Permit Fee $ USFoundation Permit Fee $ Other Permit Fee $ '',r'/3 Sewer Connection Fee $ 160n.11.0 �U--Water Connection Fee $ /h.lt> cTJ TOTAL �- i'�� Building InspectorVOL / Div. Public Works Location No. Date NORTN TOWN OF NORTH ANDOVER Ot,,60 ,.�1 O? • • 0 p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ s'�fl1USE Other Permit Fee $ Sewer Connection Fee $ + Water Connection Fee $ TOTAL $ Building Inspector 1 Div. Public Works f . PEWMTT,,NO: APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. 0,0" PAGE 1'/ MIA PI�K4O. 59 LOT NO. � 2 RECORD OF,OWNERSHIP iDATE BOOK 'PAGE ZONE 2 3 I SUB DIV. LOT NO.� F�,,o* t� It '-I iF i — LOCATIONCZikoj 66-iz Q . ` HN PURPOSE OF BUILDING OWNER'S NAME ,C),kim t7, ('H Ritom NO. OF STORIES SIZE f 3710 S� OWNER'S ADDRESS �C9 5roN/A/C,&t / -ZE�f, IVC Ab ASEMENT R SLAB —T ARCHITECT'S NAME aQGo NU' CRQN SIZE OF FLOOR TIMBERS ISTA X �0 2ND X f0 3RD BUILDER'S NAME MAQC;wA 1 4-1Ac/V SPAN /L/ j DISTANCE TO NEAREST BUILDING -7C) { ,�„��, DIMENSIONS OF SILLS ct X x /c, --- DISTANCE FROM STREET �o / " POSTS •mac /a LA LA� DISTANCE FROM LOT LINES-SIDES .i ,.,t, REAR 3�/ " GIRDERS x 1� f AREA OF LOT �'"', FRONTAGE /'k HEIGHT OF FOUNDATION Q C1 / THICKNESS IS BUILDING NEW J S SIZE OF FOOTING �� % /I IS BUILDING ADDITION NIA MATERIAL OF CHIMNEY eft/C, IS BUILDING ALTERATION IS BUILDING O SOLID R FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ') IS BUILDING CONNECTED TO TOWN WATER ujrLS BOARD OF APPEALS ACTION. IF ANY dom c _) IS BUILDING CONNECTED TO TOWN SEWER) �5 IS BUILDING CONNECTED TO NATURAL GAS LINE L s INSTRUCTIONSERMIT FOR FOUNDATION ONLY 3 PROPERTY INFORMATION LAN COST SEE BOTH SIDES REGULATED BY PARA: 114. &S. B.C. EST. i� 13 1 BLDG. COST 1 �j/ FEE Kit PAGE t FILL OUT SECTIONS 1 - 3 DATE. /� • EE PAID. /a0 EST. BLDG. COST PER SQ. FT.EST. BLDG. COST PER ROOM 7/ �i f PAGE 2 FILL OUT SECTIONS 1 - 12 �3 PERMIT FOR FRAMUBUILDING SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTfCHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDINQULe AR,—•.•_.FEE PAID.- -- DATE FILED Q9 APP, / l L BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT J FEE 3t7 f -t OWNER TEL.# (°�'�'' � PLANNING BOARD PERMIT GRANTED CONTR.TEL.# n[tj 1-71-19 -7119 9 f CONTR.LIC.# I- BOARD OF SELECTMEN U, sow BLD' FMy Z'30 i I LESS FDA FE - o� 0°10"" _ i I, AF,R 9 I Mw f� 3d `Ja BUILDING INSPECTOR UE FRAM Pm=4FWRDlNG RECORD 1 OCCUPANCY 12 SINGLE FAMILY SiOR1ES THIS SECTION"MUSTSjj H ,O�V EXACT DIMENSIONSOFLOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES LOT LINES AND EXACT ,DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED.`THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ a 1 2 ✓'3 CONCRETE BL K. PINE BRICK Q2 STONE HARDW D PIERST PLASTER ✓ +� t DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/, 1/2 1/1 FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN - 4 WALLS I 9 FLOORS CLAPBOARDS `� B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMIACN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY li—�, _ STUCCO ON FRAME _ BRICK N MASONRY ATTIC STRS. & FLOOR NG (— BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 M. ( — GAMBQEL MANSARD TOILET RM. 12 FIK.I FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR 11*1 WOOD RAFTERS wf'_ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2n� d _ ELECTRIC 1st 13rd NO HEATING i 'r � r S FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION C 2AAIgLr/I2 CA"r ASSESSORS MAP SUBDIVISION LOT(S) a C2AN gC PERMANENT ADDRESS (ASSIGNED BY D.P. . ) 5� . STREET -* 59 Lc f :kcR -C2tLjj3E2R SA E.anjz APPLICANT SC,AKI CAHrcL PHONE 683-38 DATE OF APPLICATION d i �-tA2c�-1 cj TOWN USE BELOW THIS L1NE PLAN NG BOARD _DATE APPROVED ' _ TOWN PLANNERv DATE REJECTED CONSERVATION COMMISSION �- APPROVED CO SERVATION ADMIN. �' DATE REJECTED BOARD OF LTH DATE APPROVED 3 �/ LTH SANITAR DATE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT >D A/ytL /LC -T 7/ SEWER/WATER CONNECTIONS FIRE DEPT. kU 1`t 1 {� 1 G - - i RECEIVED BY BUILDING INSPECTION r1 f . DATE } i This form shall be signed by the agents of the P'lanuing- and Heal-th Boards, the Conservation Commission prior- to the issuance of any building; per.mlts for the subject lot. This form shal.l. not rel.eive the applicant from the compliance of any applicable Town requirement or Bylaw. PLA%N'I N G, F14N FORTH FII L. own o 6 'Andover VIM No. 204 DRIVEWAY ENTRY PERMIT � K erMass. 167191 HEWICK , r A �V OR ?PERMIT T LD� SS BOARD OF HEALTH THIS CERTIFIES THAT..............1.�.P.�.''�N... e.... ..p!c 6{' . ................................ %4 --`` J q �1 A .. BUILDING INSPECTOR has permission to erect ....E+4+P.Q �...... buildings on 401* .5.1..!: A L).1 ... ... N ' Rough c • ��{{ ...� I Chimney to be occupied as.,.11�t.1i'� .. !��. .��1 VW .... ..1. R. A .. /. ��• Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the InspectioiPMWtiFORn6QIJbUll(McONLY Rough Buildings in the Town of North Andover. REGULATED BY PARA: 114. 8-& B.C. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. DATE:5'r7'91 FEE PAID PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough PERMIT FOR FRAME/BUILM&u ESS CONSTR N STA TS Service an•� Final DATE:FEE PAID•g�v ... . . ...................... ............................. BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner STREET NO. No Lathing to Be Done Until Inspected and Approved by Smoke Det. Buildinx Inspector F H "• 09WV% - 6 OL ®ver No. 204 4 DRIVEWAY ENTRY PERMIT C� � K er, Massa 7� _191 ( Aon SS _ BOARD OF HEALTH PEHMIT T 0 THIS CERTIFIES THAT..............1 O.F04...,..t...AN.*I.(a-nL. ................................. BUILDING INSPECTOR has permission to erect ... V.P.t...... buildings on ... .;r - Chimney Rough to be occupied as.�t 1�1. �l�... �. Wts VW .... .. Ak.. • Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the InspectioFPERWtiFI@Rn QWMMTI(Mc@NLY Rough Buildings in the Town of North Andover. REGULATED BY PARA: 114. 8-S. B.C. Final s� VIOLATION of the Zoning or Building Regulations Voids this Permit. DATE. ' PAPMD. oe� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR N STA TS Rough service Final .BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by STREET NO. Smoke Det. Building Inspector N° 813 .' APPLICATION FOR SEWER SERVICE CONNECTION 4 North Andover, Mass. _ G� 19 Application by the undersigned is hereby made to connect with the town sewer main ink14-42- rSl eet, subject to the rules and regulations of the Division o ublic orks. The premises are known as No. or subdivision lot no. Owner Address ./ ao Contractor AddressAn� , r Applica, ' Signature PERMIT TO CONNECTWITSEWER MAIN./ The Division of Public Works hereby grants permission to -) 6� a 44, (, to make a connection with the sewer main at ka" Street subject to the rules and regulations of the Division of Public Works. ` v'sioni lic Works 1 By Inspected by Date See back for rules and regulations �'P" 9 ^ V RULES AND REGULATIONS FOR GOVERNING THE INSTALLATION OF SEWER SERVICES 1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer or appurtenance thereof without first obtaining a written permit from the Division of Public Works. 2. All costs and expense incident to the installation and connections of the building sewer shall be borne by the owner. The owner shall indemnify the (town) from any loss or damage that may directly or indirectly be occasioned by the installation of the building sewer. 3. A separate and independent building sewer shall be provided for every building; except where one building stands at the rear of another on an interior lot and no private sewer is available or can be constructed to the rear building through an adjoining alley, court, yard, or driveway, the building sewer from the front building may be extended to the rear building and the whole considered as one building sewer. 4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by the(Superintendent),to meet all requirements of this ordinance. 5. The size, slope, alignment, materials of construction of a building sewer, and the methods to be used in excavating, placing of the pipe,jointing, testing, and backfilling the trench, shall all conform to the following requirements. The sewer shall be 6"diameter SDR 35, PVC pipe. Minimum slope shall be 1/8" per foot.The minimum depth of sewer shall be four feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown of the pipe. Care shall be taken to carefully grade and compact the stone,and prevent pipe displacement.The remainder of the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift. 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such building drain shall be lifted by an approved means and discharged to the building sewer. 7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer. 8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superinten- dent)or his representative. 9. All excavations for building sewer installation shall be adequately guarded with barricades and fights so as to protect the public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be restored in a manner satisfactory to the(town). , .s - No 202 APPLICATION FOR WATER SERVICE CONNECTION J North Andover, Mass. 9Kk Z/ 19 Application by the undersigned is hereby made to connect with the town water main in Street,-- subject to the rules and regulations of the Division of Public Works. The premises are known as No. Street; or subdivision lot no. P4 S i A, �;r Owner Address Contractor Address Applicant' Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to Tm A, to make a connection with the water main at Street subject to the rules and regulations of the Division of Public Works B d of Public Works By Inspected by Date See back for rules and regulations RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No person shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be 1" type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 41/2 foot rod and brass plug type cover. 1. L� o G DEPAK fli ENT LOT000 2 "16 vi OF A L r -�. Raj 1 MAR WLA ' r �p�r ► 0 IQ 3� r- mg,241� 1 � - 401 MARCHIONDA & ASSOC. , INC, ENGINEERING AND PLANNING CONSULTANTS ZW�` 80 MAPLE STREET R.F.O. /16 P STONEHAM. MA, 02180 MANCHESTER. N.H. 03103 (617) 438-6121 (603) 434-8725 PNV 2 9 • • - i .. v _ - Vii' ' ' ' � - - F•�r.•rs.. � - �t�' J, � • • - x� .� t mar a u� :Fi';, f$§' +'•w �'� �'�'yak �' +c t E •11rt1�OrK" •-a.i 194 ; 'F tEta�it�lt ; rx' 'MADE PA' r E s t _ r#, �E N0 g - sABLE'To. 1,989 OMMIS81ONER OF PUBLINYC Q"'4i2"S?ji� �03 RANU3iAs i All (DO NOT SEND CRS ae3P `' r► . f Om ONLY), FEE . # fL It 141 C)1a4� ,'� LEASE ,ROTE F N�Al 1 }'IEIbG,1'IT! MOT VAL'd UNiL 91dMED BY UCEIYgEE•" t {` t •rFECTI �' O SKINA ANO 0"ICiAtLY: _ �' ♦ Y ti +• _ �; T'�E CDa�on�n { A .ael V 9 'mss 7 ......s CAWIED i #t►+eMi rt - .. to ¢ s. -�. .� �� '.'�,. .r"_. OF LICFtgEQ. �•a�`l� N+1M61Nk'F•U���`Sj �•�.��.1�'�.. - .`� t-�� sr y�:. �,_t y�rt�y�at.E s -" - �:• Xi..a `1 • `L Of ryOPiN,h KAREN H.P.NELSON Town of 120 Main Street, 01845 Director NORTH ANDOVER (508) 682-6483 • BUILDINGea����0 ° CONSERVATION DIVISION OF PLANNING PLANNING & COMMUNITY DEVELOPMENT COMPLAINT FOR INVESTIGATION Date: 0//y' 1 g/ From: /xI/ j- An �l�l/�cb�ric� Address: 02,2 3 Complaint Against: ELECTRICAL: PLUMBING: GAS: BLDG. CONTRACTOR: PROPERTY OWNER: OTHER: BRIEF STATEMENT OF COMPLAINT: Signed: c I ' Z P EXISTING ACCESS EASEMENT THIS PLAN IS INTENDED FOR ZONING WE HEREBY CERTIFY THAT WE HAVE EXAMINED PURPOSES ONLY. IT WAS COMPILED THE PREMISES AND THAT ALL EASEMENTS, FROM EXISTING PLAITS AND RECORDS ENCROACHMENTS AND BUILDINGS ARE LOCATED WITH BUILDING LOCATIONS CONFIRMED AS SHOWN. ALL BUILDINGS SHOWN CONFORM IN THE FIELD. IT SHOULD NOT BE TO THE ZONING LAWS OF THE MUNICIPALITY USED FOR PROPERTY LINE DETERMIN— WHEN CON TED.` ATION. 1t OF . THE BUILDING IS NOT LOCATED .IN AN ESTABLISHED FLOOD HAZARD AREA. a PAUL ZONING: 1R3 e; MARCHIONDA REQUIRED SETBACKS: No. 30015 FRONT: 3o' T SIDE: ?n' s; ,Q REAR: 30 - IONDA, P.E. UAW CERTIFIED PLOD" PLANT�NGNEERIJNG DA & ASSOC., INC. ND PLANNING CONSULTANTS IN (-AA 8Ll"M1 baa& MAPLE STREET t AS PREPARED FOREHAM, MA. 02180 �. /Wil617) 438-6121 O' DATE: 7vivf, 1991 h,1 & A FILE No.: Sed - DI C� I� N N/F SERGI — 4.14' 186.00' 37.42' LOT 2 N/F LOT 3 25000 S.F. O 0.574 Ac. 29.92' 'o O ry 0 31.09' 2p?ay moo 35.25• � 29.94' N/ N%F I1 49g% CRANBERRY LANE EXISTING ACCESS EASEMENT THIS PLAN IS INTENDED FOR ZONING WE HEREBY CERTIFY THAT WE HAVE EXAMINED PURPOSES ONLY. IT WAS COMPILED THE PREMISES AND THAT ALL EASEMENTS, FROM EXISTING PLANS AND RECORDS ENCROACHMENTS AND BUILDINGS ARE LOCATED WITH BUILDING LOCATIONS CONFIRMED AS SHOWN. ALL BUILDINGS SHOWN CONFORM IN THE FIELD. IT SHOULD NOT BE TO THE ZONING LAWS OF THE MUNICIPALITY USED FOR PROPERTY LINE DETERMIN— WHEN CO . ATION. `JMk OF � s9 THE BUILDING IS NOT LOCATED .IN AN ESTABLISHED FLOOD HAZARD AREA. PAUL SAA MON n ZONING: 0 3No. 390 4 REQUIRED SETBACKS: FRONT: 30' �',� E IST SIDE: 20' REAR: 30' L A. HIGH P.E' to'u ATE •� ._;.._-. - _ ��::_.,�u�::,--r-.,•, ,...- 'cam CERTIFIED PLOT PLAN MARCNIONDA & ASSOC., INC. - aT ENGINEERING AND PLANNING CONSULTANTS IN NOK(1"H AND0VL-,,V p 80 MAPLE STREET AS PREPARED FOR STONEHAM, MA. 02180 (617) 438-6121 _. SCALE: 1"_ .40' DATE: 1UNE mil M & A FILE No.: N N/F SERGI - 4.14' 186.00' ' I 37.42' LOT 2 N/F LOT 3 - 25000 S.F. >>� 0.574 Ac. 29.92' 'O O L� o �����0 u L_ -,, gyp. �• —` i 31.09' 2p?Ag L�UU 35.25' ' 29.94' N%F I-OT 1 a98% CRANBERRY LANE EXISTING ACCESS EASEMENT THIS PLAN IS INTENDED FOR ZONING WE HEREBY CERTIFY THAT WE HAVE EXAMINED PURPOSES ONLY. IT WAS COMPILED THE PREMISES AND THAT ALL EASEMENTS, FROM EXISTING PLANS AND RECORDS ENCROACHMENTS AND BUILDINGS ARE LOCATED WITH BUILDING LOCATIONS CONFIRMED AS SHOWN. ALL BUILDINGS SHOWN CONFORM IN THE FIELD. IT SHOULD NOT BE TO THE ZONING LAWS_ OF THE MUNICIPALITY 3 USED FOR PROPERTY LINE DETERMIN— WHEN CONSTRUCTED. ATION. THE BUILDING IS NOT LOCATED IN AN Of � q�s ESTABLISHED FLOOD HAZARD AREA. . pA0i ZONING: R3 MANCliioN a tYO. 01 REQUIRED SETBACKS: FRONT: 30' .� cS E `�� SIDE: 20' / 6 3 REAR: 30PAUL A P.E. DAVE CERTIFIED PLOT PLAN MARCHIONDA & ASSOC., INC. ENGINEERING AND PLANNING CONSULTANTS IN 4-CIT �l - rk'ANi,3Ex'k"Y 4 Avr ; fV0('T'" 'rquDovck" (A. 80 MAPLE STREET AS PREPARED FOR STONEHAM, MA. 02180 J f�k C 4/1)L.L (617) 438-6121 = SCALE: 1"= 40� DATE: PivE, /qq/ M & A FILE No.: CERTIFICATE ®F USE & OCCUPANCY Town of North Andover Building Permit Number 204 Date_ OCTOBER 25, 1991 THIS CERTIFIES THAT THE BUILDING LOCATED ON LOT #2 - 59 CRANBERRY LANE ' ! f MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAM ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH l • OTHER REGULATIONS AS MAY APPLY. NORTH 0 4. o= a CERTIFICATE ISSUED TO John P. Cahill ti p ADDRESS 59 nberry Lane o e^ �SSACHUS�� Building Inspector Town ® :. 6 OL ®Ver - * DRIVEWAY ENTRY PER1�1'I�"� - - 17 HEWIC K er, Mass. MAY 1911 qO� Pa\\ 4 P.E.RMIT T BOARD OF HEALTH _ l It 'THIS CERTIFIESTHAT..........:... .Q.+:N...�..t....... has permission to erect .... ��.�...... buildings on iYbN • E 1 BUILDING INSP CT rQ •• an • to be occupied as.wit 1 ALS..��!Nt��. �,1�1 W ,•„ ,,��,,r!T'R• A ; �. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in MB NG NSPE R I r_ F@RPFQUNMTI0Mc@NLY Rough �� � this office,and to the provisions of the Codes and By-Laws relating to the InspectiorP��ti g Buildings in the Town of North Andover ` "' REGULATED BY PARA. 114. 8-& B.C. 1� �,- ? VIOLATION of the Zoning or Building Regulations Voids this Permit. DATE: 5'-r7-91 FEE PAID:-.._ ''"� PERMIT ;=EXPIRES IN 6 MONTHS ELEC RICAL IN EcroR . , e Rough 4.��.� PERMIT FOR FRAME/BUILM" ESS CONSTR N SATS Service5m �;.� �r Final - DATE FEE PAID•J...,,_S 4140 ... . . ...................... ............................. BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building u Display in a Conspicuous Place on the Premises , FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by STREET t e— Smoke Det. t Building Inspector ector ' AtWli LF- TOWN OF NORTH ANDOVER OE pORTF/ 1 APPLICATION FOR PLAN EXAMINATION �.�to ao '6 OL * a^ « Permit NO: 25'- 2-6 Date Received l � '9A,..,.._—•.*�« ��aS�cNus t Date Issued: 1 j IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER_ AM LoVC 1 a 4 Print MAPNO.:0T PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING IIISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential 0 New Building W One family 0 Addition ❑Two or more family ❑Industrial iAlteration No. of units: Repair,replacement ❑Assessory Bldg 0 Commercial ❑Demolition 0 Moving relocation ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED R, ,A0,10,W, exi4t*A Cj ekc6, d orc,V% w I KAW �,00<<A w►,ol �a;1i� K!,1d wua 1a�nd�� s Skai(S i-o yyQ�d . 1�S�all wkr I�nrc.l^ 'Qcsks,$GlC�iv1S owt� r�tij; ti. 4.1uw j it Sk.cl '►^, bc1 . >rX�S�t r►9 4-P,0 - F V%ftrf. �IeNM�C �^o !l'rvVlQi n. Identification Please Type or Print Clearly) OWNER: Name: C 101Phone: 617 - S8Z8 Address: 59 Cry 6ce'r 11) CONTRACTOR Name: o1 t ► Vi t �c-.,3+r.-29 ,aJ k1.444hone: $t 3 3500 Address: 16 �01^S 15A ., `^ Supervisor's Construction License: G 5 - 0 6,6 9.5 Exp. Date: 8 )v.117 � Home Improvement License: J 3 8�60 Exp. Date: 3 4) 17 d ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 5 3,0 0 o x 12.00=FEE:$ 636 Check No.: Z 159 Receipt No.: Page 1 of 4 IE!