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Miscellaneous - 59 ROCKY BROOK ROAD 4/30/2018 (12)
,o/ 59 ROCKY BROOK ROAD^ C=-z�' 210/090.A 004&0000.0 2012 Massachusetts Electrical Code Amendments 527 CMR 12,00§Rule 8: In accordance-with the provisions of M. 143,c.143,§.3L,the � ,permit application form to provide notice of installation of whin shall on the prescribed form.After a permit application has been accepted by an Inspecto�ogfhWhout ehee pp tea p alth,and app to M.G.L cficatio. 1shall 66, b3 filed p electrical permit shall be issued to the person; 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 ofongoing construction.activity,and maybe,deemed-bythed'aspector_of_Wixes;tabandoned_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. El The Permit Extension Act was created by Section 173fCiiapter 240 ofthe Agts of 2010 and extended by Seetions.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 Purpose by establishing an automatic nsion Ac g atic four- ear e t furthers this y extension to cert ' limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration dag theuso or tevany permit or approval that wnt of real property. as "in effect or existence"during the qualifying period beginning on August 15,2008_and extending'through August 15,2012. ule —Perm"ate Closed: 7 / * *Note:Reapply for new permit ❑Permit Extension Act—Permit/Date Closed: TOWN OF NORTH ANDOVER - _ , , PERMIT FOR WIRING 3 ,SSACMus� - i t pj t� is This certifies that © j. ... ........... ............ ... has permission to perform .. �... ...... wiring in the building of............. / n..��.. £. ........................... Mz .... . ..... ' Q .....:... SC....A?x /CrR North Andover,Mass. Fee-06............. Lic.No.:�. ......... !,¢ ECAL INSPECTOR/ Check # V $767 _. P� C'ommonivealth of Massachusetts Official Use Only v. Permit No. /577 6 - Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 9/051 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL MFORMATIOIA9° Date: ' r x�r. of-' City or'Town of: A111il—vy ,- To the In rector of Wires { By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) �jQ��i�G Owner or Tenant /P�SJeII /l�Lj//t" Telephone No. Owner's Address Is this permit in conjunction with 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: e S, k1 Completion of thefollowing table may be waived by the Inspector of Wires. �iNo. of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above Ei In- o.omergency Lighting No.of Luminaires Swimming Pool rnd. grnd. ❑ Batte ry Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMSNo.of Zones No.,of Switches No.of Gae-�Sa No.of Detection and 6'If Initiating Devices No.of Ranges No.of Air Cond. Tons Tot5;-' No.of Alerting Devices No.of Waste Disposers Heat Pump Number. Tons KW No.ofSelf-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local El Municipal Connection El Other - No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 3i . 00 (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:) Etc, /-k/�W/c/ 1 certify, under the pains and peva hes of perdu ,that t e information on this application is true and complete. FIRM NAME: f LIC.NO.: Licensee: .. ����" . � /! � Signature LIC.NO.: (If applicable, r" pt"in the li ense.number ine.) Bus.Tel.No.: .� Address: /lC' ®O Alt.Tel.No.: .7 *Security System Contractor License require for.this work;if applicable,enter the license—num er here: OWNER'S INSURANCE WAIVER: lam aware that the Licensee does not have the liability insurance coverage normally check one))❑owner required by law. By my signature below,I hereby waive this requirement. I am the g owner's agent. . b Owner/Agent Signature Telephone No. J PERMIT FEE. $ a19 .ot. .� The Commonwealth of Massachusetts Deper_imept or1ndust,-W pcciderfr •` Office of Inveyfigadons RJ ' 600 Washington Street Boston,MA 02111 IY n'cers' Compensatioi;I-fi<urnice Aflld2vit: Build--rs/Contractors/Electricians/Plumbers A '-.1:.r-f.Information Please P 'nt Le ibiv Name ,i t4iness/OrganizztiowIydi-eidual): Address:_ City/State/Zip:__ Plione#: Arc you an employer?Check the appropriate box., Type of project(required): 1.0 1 am a amployer with 4• 01 am a general contractor and 1 �,f ploy ees(full and/or part-time).* have hired itte sub-contractors I E• ❑?`lege'construction 2.',t�J 1 am a sole proprietor or partner- listed on the at=hed sheet- ! 7. ❑Remodeling -shipand-ha-vc-ao-ernplovees--- — _ - These sub-contraGtcxs terve -8.--0 Demolition working for me in any capacity. employees and have workers' -- (No workers' comp,insurance comp.inran suce.t 9• E]Building addition required; 5.[ J Vire are a corporation and its 10. Electrical repairs or additions 3.13 l am a homeowner doing all work officers have exercised their 11.❑Phtmbuig rcpaits or additions w. myself. o workers' right of exemption per MOL y comp, ,152 . 12.n Raaf repairs insurance required.]f c §1(4),and we have no 13.[1 tither employees.(No workers' comp.insurdnces required.] `Any applicant that cheek;box 41 must also fill out the stiction below showing their worke i'compcusxtioit policy information. f Homeawcers who submit tbis aPitinvit indicating they arc doing all work and thea hire outside e511nnctor9 must submit a new aPtidavi:indicating sue%. tCont=tor that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or no:those entities have employees. If the sub-wntrnotors have employees,they must prv�ide their workers'comp.policy number. 1 ant an employer that hrpi-oviding workers'compensadon Ins_ur_ance for itty emptoyees. Below is thePolicy and job site information. Insaratwo Company Name: Policy#or Self-ins.Lic.#: , Expiration Date: Job Site Address: City/State,Lip: Attach a cops 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$%SOO.00 ardor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Officc of n e,ti ations of-he DLA fo insurance-covera-e vt ri icatian: — - - I do herehp certify under thefpamr and penalties of pei jury that the information provided above Is true and correct Y Si nanlre: lata: � e Phone#: OBIcialuse only, Do not w e in tki I area,to be completed by city or torten gSzdal City or Town: PermitlLicense# Issuing authority(circle one): 1.Board of Health 1.Building Department 3.City-ITown Clerk A.Eletrsic.J Insprstor 5.Plumbing Inspector 6.Other Contact Person: Phono#s S0 2 6 Date.................................. �aORt►r TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4A ,SSACMUS� This certifies that /�tt ., .. .... ..:. v�,- s has permission to perform . ......................... ......................................:...:.. wiring in the building of . ............................................'.......... 'y at.......... .!........1....�, {! !.. �?.7G-........ rth Andover Mass Feefq.............. Lic.No. . .`� ...... ............ ......... ELECTRICAL INSPECTOR . Check # 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143 §3L the A1 permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed "I 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 J 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 ofongoing contraction activity,and may be-deemed by.the,Inspector_of_Wires 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¢tmitt apjitcation. . 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 effector existence"during the qualifying period b ginning August 008 and extending through August 15,2012. C ule 8—Permit/Date Closed: 'Z / ** Note:Reapply for new permit 0 Permit Extension Act—Permit/Date Closed: Commonwealth of Massachusetts Official Use only Permit No. 10 13 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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 IN INK OR TYPE ALL INFORMATION) 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) E9 Owner or Tenant A—t kQ t,4z9f EkS Telephone No. Owner's Address — k- IE Is this permit in conjunction with a building p rmit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building 51,t- L5-- Ffi,�,kLt..Q I�Z' S iC)Ep-Q-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: [ &V J Al e r Com letion of the ollowing table may be waived by the Inspector o Wires. No.of Recessed Luminaires 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- ❑ Battery o.o Emergency Lighting rnd. rnd. 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained Totals "" "'" """""' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection L,� No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Estimated Value of Electrical Work: F(7© Attach additional detail if desired, or as required by the Inspector of Wires. (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 the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Vi _ GAY,—k >-JET t (, A-*J LIC.NO.: -3-3466 i- Licensee: %j � 0-,k-"j-- w E)rp{-f--LT-Signature LIC.NO.: (If applicable, enter "exempt"in the license number line. Bus.Tel.No.•�7�— Address: s� t — l �� Alt.Tel.No.: *Per M.G.L c. 147, s.'57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one) ❑owner ❑owner's Owner/Agent FPE"IT FEE: $ Signature Telephone No. l The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address:—S Sifn (2-E PD City/State/Zip: � Jg po�Eg- /{A.O"P4- hone #: 92E- 36 6 - �S3 I I Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction f loyees(full and/or part-time).* have hired the sub-contractors 2 I am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. El We are a corporation and its required.] officers have exercised their 1Iectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance.Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to.the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the A for insurance coverage verification. I do hereby c r afy undert pains d penalties ofperjury that the information provided above is true and correct Signature: — /? — / Date: Phone#: 9-79- 36 6 � 3 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#: w...-...�-r'w-.r,.....�a.rw�.�r+�.:-+a,.e:+t.:..may.»-• ---` - _ _ . ,f-4;,..r^+�.ri-Y.,.:�.t�..s.-...+.� _ :! E Date............2....... I I ORTM,� 3?' TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 14F o 4: 88ACHU HA,2��l U Thiscertifies that .................................................................................................................... has permission for gas installation .� .. mss. ......` in the buildings of. `7.......... ... ........ { ,at....... ...............................e t....:... lL..... North Andover,Mass. �FeeM. . ..... Lic. No. ........1 Y...... GASINSPECTOR Check# � 8947 I (9 s pcx cS - 3aa5' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK l: - CITY I NORTH ANDOVER MA DATE OCT.28,2013 PERMIT# JOBSITE ADDRESS 59 ROCKY BROOK RD. OWNER'S NAME I RUSSELL NORRIS GOWNER ADDRESS RUSSELL NORRISTE 617-312-8653 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL® RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:® REPLACEMENT:® PLANS SUBMITTED: YES® NO® APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 1 11 1 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER . COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE ® 0 FRYOLATOR FURNACE GENERATOR GRILLE _ 1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER �— WATER HEATER �� OTHER f INSTALL AN UNDERGROUND GAS LINE AND CONNECT TO A PLUMBERS INSPECTED LINE INSURANCE COVERAGE 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 iA LIABILITY INSURANCE POLICY [D OTHER TYPE INDEMNITY ® 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 AGENT SIGNATURE OF OWNER OR 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 my kn ledge and that all plumbing work and installations performed under the permit issued for this application will be i o li nce with all Pertinent ion th Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME I JOHN MARSHALL LICENSE# 778 SIGNATURE S MP® MGF® JP® JGF® LPGI Ej CORPORATION[J# PARTNERSHIP®# LLC®# COMPANY NAME: EASTERN PROPANE GAS ADDRESS 1131 WATER ST. CITY DANVERS STATE MA ZIP 01923 TEL 1-800-322-6628 r.� FAXI CELL JEMAIL= J � N r . r The Commonwealth of Massachusetts Department of Industrial Accidents r` Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant-Infer-mation Please-Print Leizibly EASTERN PROPANE&OIL Name (Business/Organization/Individual): Address: _ 131 WATER STREET , . ... 978750 MA..01923 Phone # Y employer? appropriate Type of project (required): Are you an em to erg Check the ro riate box: 1.:�✓ .I.am a em to er with 45 4 `❑ I earn a general contractor and.I p Y '6.J7 New construction "employees(full and/or part-time) * have hired the sub-contractors, 2.0 I am a sole proprietor or partner- listed on the attached sheet: kern.modeling, ship and have no employees These sub-contractors..have . - g_ ❑ Demolition - workin for.me m ari ca aci employees and have workers'., g Y p tY 9: ❑ Building addition comp. insurance.$ [No workers comp. insurance i 10:0 Electrical re airs or additions re uired. 5. ❑ We are a corporation and its P _- q ] _ officers have exercised their. •1:1. Plumbin re airs or additions 3.[]' 1'am a homeowner doing all work ❑. . . . g. p myself. [No workers' comp. right of exemption per,MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no GAS FITTING employees. [No workers' 13.0✓ Other comp. insurance.required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ENERGI Policy#or Self-ins.Lie. #: EWGCD000080613 Expiration Date: 03/15/2014 Job Site Address: oc - �JoaLk City/State/Zip:a,,`1-Q �r�clyLpi,lrn�,.U1�4� :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. I do hereby certify under the pains and enalties 2fg!: 'ury that thein ormation provided above is.true and correct. Signature: -- --- i Date: Phone#: 978-750-6500 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 I I I !, i - at �illvrc�rluu �il_III c:�i, MAS AI,iIi.I�U1 ism � Y � ►� � 'mmis klmlal L 5uS AND GASH n AS Ari! IQ GAS fC�l l 41,15 15SLIE5 TML=ABOVE LIL.tEI1ISk N�; I i� II IIAhS DIIIII.IAI_l_ II I '. ?. li11I1AhT STREET lhl'nt. I111925 i L) DAHVERS III 77E1low 05/ql./lc� 1tl it � i- in 'rim k I I I i I; :I Date .t3... 1 ® 240 ,• 0*"OR TOWN OF NORTH ANDOVER ° 9 PERMIT FOR PLUMBING . �BgCHu 6ej Thiscertifies that....................................................................................................................... has permission to perform.X. . .. ! ! -.r- P��.ea ,.............. V.—W ,P1 r plumbing in the buildings of... t ................ .. .. 7 ,- at.J. ..�.....................I. North Andover, Mass. Fee .......a. ....LIC. No PLUMBING INSPECTOR Check# w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK M� ' CITY MA DATE Do--! ( PERMIT# � V JOBSITE ADDRESS Ro :1 VL<- � OWNER'S NAME LR, P OWNER ADDRESS S9 / r R 1 TEL�s� FAX — TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: 0- RENOVATION:® REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO FIXTURES Z FLOOR- BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I I CROSS CONNECTION DEVICE L-1-:1== DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM k ..-_._..� ____t _.__.._I ._.__JI ..___..__.k __( [ DEDICATED GRAY WATER SYSTEM ! - ._ k k,. I _ _ _f 1 _._._._._! I l I _k DEDICATED WATER RECYCLE SYSTEM —I= __._.._!I _ .-__ -DISHWASHERkDRINKING FOUNTAINI .---_-..,( ._--_--._... ..__.kFOOD DISPOSER - iFLOOR/AREA DRAIN -�INTERCEPTOR(INTERIOR) _.__kKITCHEN SINK SINK -- — _ ( k - - -_J LAVATORY � � ; _ ROOF DRAIN SHOWER STALL Pr _--...f —_ 1 k SERVICE/MOP SINK ___-TOILET ___-_URINAL _......__...kWASHING MACHINE CONNECTIONWATER HEATER ALL TYPES WATER PIPING 21Z OTHER I ( _I INSURANCE COVERAGE: J 1 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[ 'NO �]1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ,,nn LIABILITY INSURANCE POLICY _ OTHER TYPE OF INDEMNITY E111 BOND 0 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. 0 SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER Q AGENT J 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 al Pertinent provision of the h4assachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I LICENSE# Slv ._,. ( SIGNATURE MP 0 JP CORPORATION�J#©PARTNERSHIP D# ��LLC COMPANY NAME 5er10ptT Plvm�kr!j A1^Jj ADDRESS _ f CITY L Inn STATE I_j"I 1—a -11 ZIP U I�O`�{ �� TEL FAX CELL —EMAIL � `� °A Y i . r R _ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ - "7,V. FEE:, $ . PERMIT# PLAN REVIEW NOTES e 1 r E 'ti The Commonwealth of Massachusetts - Department ofIndustritcl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (Business/Organization/individual) 17✓tQ f vn�1,211171 ,V 9 Address: �� /�•'"o�� ./ City/StatPhone#•_ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. E]New construction mployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.E[Plumbing repairs or additions myself. [No workers' comp, c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees. [No workers' comp.insurance required.] 13.❑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 aie 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:. Policy#or Self-ins.'Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage'as 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. I do hereby certo under the pains and penalties of perjury that the information provided above is true and correct. - Signature: — Date: /0" 30— /-3 Phone#: 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.PIumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." 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 orpartners,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 ' Y q in 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 permit/license number which will be used as a reference number. In addition,an applicant that roust 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 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 Coni onwealtia,of Massachusetts" ` Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston}MA 02111 Tel,#617-727-4900 QXt 406 ox 1-877-MA.SSAFE Revised 5-26-05 Fax#617-727-7749 www.mass,gov/dia "HCT.�"r'Y ...�..7Rt4Cr.fr73*wrs.^,--:.,}F�-'l.ri+yt�'�+�.s"Kr`Y"'+!-r*,.,F="-:84.G''�;j4.7c=rr.✓� —.TT':�yJ},iF Location t No. Date IV+4 �i ` r NORTh . TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ J uss�cwuFoundation Permit Fee $ Other Permit Fee $ Sewer.Connection Fee $ Water Connection Fee $ TOTAL $ wilding Inspector g 7693 Div: Public Works `Location ��; -Zcv—tJ T9 No. Date ra +( NCRrM 1 TOWN OF NORTH ANDOVER o p `..`Certificate of Occupancy $r •' o *'o Building/Frame Permit Fee"` $ Foundation Permit Fee $ u. ��cHus •: Other Permit Fee $ -� ,.Sewer Connection Fee $ 1 r Water Connection Fee $ TOTAL I S � ,. Building inspector T-12 '7622 `�— Div Ptbiic Works • x Locatiori G foi No. Date /0-/Z— 4 14OoT. TOWN OF NORTH ANDOVER3 b o - ; Certificate•of Occupancy $ Building/Frame Permit Fee $ ,�'�ss tom; Foundation Permit Fee $ r Other Permit Fee $ °p Sewer Connection Fee $ WIPd' Water Connection Fee $ TOTAL4e" $ dig 17 t o lZre �f t996 b`c �s DIWPu fic Works I: V PERJIIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 ,p� A LOT NO. 2 RECORD OF OWNERSHIP DATE 711 K :PAGE `'7 _ s TONE SUB DIV. LOT NO. ! (1 2 � of j , ZZ7 ' LOCATIONI` 2/J iC�oL@O1&0 C� PURP SE OF j C9G 1.11 �i _7inl'[C v�4V OWNER'S ADDRESS BASEMENTOORESLAB SIZE /� t A 0 2 5 I�c.Seh 1` S ARCHITECT'S NAME /I SIZE OF FLOOR TIMBERS 1ST h0+ 2ND 'ftp>� 3RD ' BUILDER'S NAME Q� ! /� �T{2 SPAN t y DISTANCE TO NEAREST BUILDING c> /� 0 t DIMENSIONS OF SILLS /l17, !� u— /C – DISTANCE FROM STREET POSTS 7 DISTANCE FROM LOT LINES SIDES -3..)l y /CJ: REAR GIRDERS AREA OF LOT B� � Q����• FRONTAGE 6c7,5-&1 - HEIGHT OF FOUNDATION 7� t /1 THICKNESS IS BUILDING NEW / ,� S SIZE OF FOOTING © t° X Z® tJ IS BUILDING ADDITION A/� MATERIAL OF CHIMNEY IS BUILDING ALTERATION No IS BUILDING ON SOLID OR FILLED LAND. WILL BUILDING CONFORM TO REQUIREMENTS OF CODEI/�C IS BUILDING CONNECTED TO TOWN WATER VC BOARD OF APPEALS ACTION, IF ANY ( J IS BUILDING CONNECTED TO TOWN SEWER ItIr.) IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS PERMIT FOR FOUNDATION ONLY 3 PROPERTY INFORMATION LAND COST _ SEE BOTH SIDES REGULATED BY PARA 114A& & EST. BLDG. COST PAGE I FILL OUT SECTIONS 1 - 3 - EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 DATE FEE PAID EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DAT ILED Lb ZS BUILDING 1 PBCTOR -� S RE OF OWNER OR 1 ED AGENT �-F E E IGOVRKFa1 OWNER TEL.a _�82-777 `]� m PERMIT GRANTED I �i� � �'�p� CONTR.•TEL. >RF 19 DUE FRAME PERMIT� 3 �. CONTR.LIC. ��2 t"" H.I.C.# PERMIT FOR FRAME/BUILDING f tt I ` tiCT 2 9 04 DATE: FEE PAID-• r i BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ S-ORIES ' THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES -LOT LINES AND EXACT DIMEN51ONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION I $ INTERIOR FINISH _ Y V,IJ CONCRETE a 1 2 13 CONCRETE BIL K. PINE BRICK OR STONE HARDW D PIERS PLASTER 1/ - _ DRY VJALL'�. UNFIN. ✓ 3 BASEMENT AREA FULL FIN. B M'T' AREA ^v< '/. '/o °% FIN. ATTIC AREA NO B M T FIRE PLACES T HEAD ROOM _ MODERN KITCHEN 4 WALLS II 97 FLOORS - + CLAPBOARDS B 1 22 f 3 DROP SIDING CONCRETE WOOD SHINGLES'' EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COM. TIL P 0 W11 JE 0 -1huoi Roll mp3lq VERT. SIDING ASPH. TILE :.a.r 6RlFSkLF7t ...a STUCCO ON MASONRY 1r� `! A `6 E;� ,�y STUCCO ON FRAME �" BRICK ON MASONRY ATTIC STRS. & FLOOR (- BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I-i POOR _ £ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE IBATH (3 FIX.) Z - GAMBREL MANSARD TOILET RM. 12 FIX.) - FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO _ r a 6 FRAMING I i l HEATING WOOD JOIST PIPELESS FURNACE197%AM '" FORCED HOT AIR FURN. •roc TIMBER BMS. &COLS. - _ STEAM STEEL BMS. & COLS.` _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS .7 NO. OF ROOMS GAS t OIL B'M_T �� 2nd _ ELECTRIC 1st 13rd 12 NO HEATING +. .�.,� u _ �Y+r-i. 4y e!% Town of ALover No - 484 dover, Mass., za 19,14- : I F' q�V t 2 n t e o 1� . B BOARD OF HEALTH i Food/Kitchen i a Septic System : . PERMIT ToILD BUILDING INSPECTOR THIS CERTIFIES THAT.... K -................. .................................................................................. Foundation rt 3 has permission to erect..I .... MP— buildings on ..�..I.8..........�..�4 .` � '' ... Rough ' t0 be Occupied as QM.M.7GSMLU.4 .. .. ...Q,,... .................................... Chimney provided that the person accepting thisemit shall in every respect conform to the terms of the application on file in Final 'this office, and to the provisions of the Codes and By-Laws relating to the Inspectio n tUUIYUAT1U1Vtiamn Buildings In the Town of North Andover. PLUMBING INSPECTOR 11 REGULATED BY PARA. 114.8-S. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough � �y- FEE PAI OC7 Final I'ERMI T EI�II�ES IN IVO 5 ELECTRICAL INSPECTOR UNLESS CONS-rL ': S X.66 P Rough :PERMIT FOR FRAME/6UILDING Service .... ..... . ...... .................. ' BUILDING INSPECTOR DATE: f� q FEE PAID-• •d-DS Final ' Occupancy Pei7nit lZegt.cired to Occc.epy Buildi_n`� GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough .. _ P Y P Fina No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT + n Town o � , ,F � rrti 4 over 0 _- Tort dover, Mass., � ' _ 1914- ° `- LAKE COCHICMEWICK A°r T E D BOARD OF HEALTH T Food/Kitchen PERMIT To Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.. K ................ ............................................................7................... Foundation has permission to erect-LA330.... F_ buildings on ..x.18.."".... ..��. ....� Rough to be occupied as Qp�uE.. OMI ..".. �4►Q,,.r�Af�....13i�1 ........................................... Chimn ey provided that the arson acce tin this�mit shall in eve respect conform to the terms of the application on file in P P P g P every P PP Final this office, and to the provisions of the Codes and By-Laws relating.to the Inspection tiJUTAItUN SNL . Buildings in the Town of North Andover. PLUMBING INSPECTOR REGULATED BY PARA: 114.8-S. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough MOT FEE PAI Final PERMIT EXPIRES IN 6 TELECTRICAL INSPECTOR UNLESS CONS U r S -�I� AS Rough PERMIT FOR FRAMUBUILDING Service S - BUILDING INSPECTOR Final DATE: �� 4- fEE ID•m` ancy fx(zqutred to Occupy BulldTng GAS INSPECTOR Rough Display in a Conspicuous 'Place on the Premises - Do Not Remove Final � P Y P Final -- _ No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT � Burner PLANNING FINAL CONSERVATION FINAL street No. DRIVEWAY ENTRY PERMIT smoke Det. SEWER/WATER FINAL <41-7 4,Z? f FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: fo C-'GG me-S Phone 453' 620 LOCATION: Assessor' s Map Number -D Parcel Subdivision C- �,��4 - , Lot (s) e Street �� t`a, CCQ st. Number Use Only************************ i RECO NDATION F TOWN AGENTS: -hY _ ✓l Date Approved Q ,.5 Core_ �at-�i Ad:�inis t.�.rator � Date Re j ec..ed T Coirument_s cjo\we�\ Date Approved 3` 12 Town Planner Date Rejected Cc=ents Date Approved Food Instector- ealthDate Rejected Date Approved l Septic Inspectcr-Health Date Rejected Co=ents 1 Public Wcr:;s - sewer/water connections -1Z driveway permit Fire Departure,^.t OVA-Q V /37may Received`by Building Ins:, ctor Date p OCT 2 e P94 ; f {r COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY I faitura t�.'c;; - Ci r7 apt OF 1010 COMMONWEALTH AVE. " MASSACHUSETTS BOSTON MA 02215 Co if 1.7: "'' ' « ,trtce of this hert-m-0. CAUTION EXPIRATION DATE ' • '� I FOR PROTECTION AGAINST Y RESTRICTIONS EFFECTIVE DATE LIC NO. THEFT, PUT RIGHT THUMB - ; PRINT IN APPROPRIATE BOX ON LICENSE. ' o 0 r BLASTING OPERATORS m MUST INCLUDE PHOTO. ..:r PHOTO(BLASTING OPR ONLY) FEE, NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY _ HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: THIS DOCUMENT MUSTr BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIEDON THE PERSON OF ^� Slssl URE OF LICENSEE THE HOLDER WHEN EN- OTHERS-RIGHT N-OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. Cy �IV c1LYN!!l/IONER - . r SSA o l__ ° + $ {J { 1 !t { Stt7 f 1 t:. I ,j► , ., r y :� , r + x -'+n tit �f -. Y ✓.i:{? � .+fit .{ ?,.r� r, rh ti,m k z . :: � ��.# } v :".... 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OA� REGISTERED,STRUCTURAL ENGINEERS DENCO ENGINEERING, INC, NEW YORK ---------------- 17301 SMUCTURALENOMR3 MAINE ------------------- 1519 148 Park Street. NEW HAMPSHIRE ----------- 1196 VERMONT ---------r ------ 2009 North Reading,MA 01864 MASSACHUSETTS ----------• 6669 CONNECTICUT ------------- 7187 (617)944-8440 .(608)6648733 RHODE ISLAND ------------ 3017 KENNETH DENNISON, PE MEMBER -AMERICAN SOCIETY OF CIVIL ENGINEERS PROFESSIONAL ENGINEERING SERVICE SINCE 1956 Joe— � 1 L o MET NO.----.-j OF JOB R9 '/Go-9 DRAWR By VAT6 REVISED OATS CO 1994 DENCO ENGINEERING, INC. CLIENT ATTIC 20 x 8 1G.o SI�AN = $�o A2r:A "Z JOISTS N� 2 rl Ce1L, , !D x P* It �f p L SF'A15 -Z-" h t. y n x 13 52 o JL( = I S�o x.8>/F '' !2 0 00 /t�1•S[.5 x[S'A a 187' (-(, SO x 13 Lsp SZ�fpO �oD 2 - llg LVL ba1yb(oxt7./, � !WALL + x L.33 g�Al L SPAQ = 341M . Sa-?.-> x14- t122SD zlosl 2oor- , 4o x 8 3zo ju,G. WA .L+ fah+ + Lo.j go �2�00 ' SL. S USE 2x�oG�l2 5,t 1 v L KI13FAv1Cyct1NG �aop 14 C) 7r 1/ YqO t2o = 44-0 SQAN - 14� Mt �lCox tl1g = ll2?D �� Sz4ioo ° S2.D ?-L3q.x92 LVL 4 . 0s s f'Art = 13� 3o x t3 3°lD + 30 l y 20 (3f-1 . 5' 5 PAN o C L. x l _-�� Seo M ° x A r s<re--�-e W A 3-¢gX9Z. LV4 X8,9 "3 MAw F-NrR, sPA.- r L X4 sCoo k I�.c�& Il 838 RooF 4o h Io AJ KENNETH �y o DENNISON z No.8889 o STRUCTURAL y ; tom 1 . TC',,y// ���/��^ I B f _ _ _.-; . .... .... . 1.4 e I rrr 6 j �� -� � '�i Fbr3h:�irrTti��d•enrr� � -1c_ _ _ _ .. ... -_ - 'i • 2 H _ Al rne-rrbc+s ore J Af i4 ifi fJl .&:'�1�D F � _ I AIJJCI� ct0-- --H�AMIN-C Alan Cc-rrt�ll3 �� Nps+-10-94 THU 13 :51 DENCO ENGINEERING INC 508 664 9233 P:�3 __, hiQV ►�� $i 1.�3[ JSuUpC DEV. mo OR 1i1��•" µ s 4 T i�i�h•* t �'vol 77 it � 1 1' 1 L 4 .. .- -_r r. •,.-.:• L.:T t 1 t-'r Gr T 1.1 i T L.1 i _c L1!-. r.r-. '�•- 7 7 4 Y � r N0+1-i0-94 THU 13 :52 DENCO ENGINEERING INC 508 664 9233 P'. 04 �4 7x .51 fl:juUU{'r {V tl.•'. ?• Ni nl Li 11 � 1 }'l ` ' .Y♦r+.-'r-..-a+..+ - (y a .�_,1..,, 11 { t�c)GI 1:0 {I 1 .. pain-�ar•Sx.Zxui:F�aetx�o� i Yz – Mw;1 k5 ssx 15�!ItxJ� // h !n_ ' 70',91 ti rj.Y.Z 1311 � ,: l'td9zZ 1: m71 - ^� t `1.�.8 1tX V41'i t s;v,n fH IjIOS&A N—1 O,LL CCI ncna=4 bra ~ _ $ • rr, t I��Id Z t_ � _- �1 a I _ MCl''+'—1 Gt-94 THLI 1 :,53 DEtjCC, ENG I NEEP I NG I MC 508 66.4 y=et== — — �.. �_ —_ 'wrs�-r�.r��r.uaaa�.'Swrr,far�nn'rr�...+q„`...�-....r..nK.uG�J•9:w� _ __ ..�-l. -_.�J.l.. �4. , . no.y �IAiLm.YrY10pM.r"CP1!R•.•"'S. r=7'-�� n..aa racnru•..�..w�?a`r!+. .. 'a'-a�".S'.c..1�♦ i . I 1 (". J t• `,I 1 .1 ( ` i�• i f I{ Y,�q •,� } Int +{pit t.: 1 . q i • w t _ { _; •fie: I' C. 3 'iV +'.rte' ! 7 }• ra�+j 'f f ' u -�--5--- L�"'_•'r,"f__,�r`_•ll t �• � 1� t•F�"`Y—#- cX --�t H ' �' � ; � , `/ •� I ter,,. l 1 111 Ci '�� J � ...- �_ •. �� � F' I -� iti i ' � 1 {i __ttom� f gt wnA fgotr� Q 'below q q,,e(mit) , 1 r.• 1 . �!p,,o'��'?�'•j�t � 11 _ �N may. � " . � .••c�_. � _.. - r S� �.] = j, �; L4 ,1 �+�`it '� 1. T�� -� -- ...-_�:.:.;� _ - Vhi. ```iK.•ti ���vni•1.rit' ,L��t�l-1i1�6�r l3:Yi�crY Y,��YY�lii.3ird`(�•�'4ti &CIL Lo��— Location �� No. `t�c��- Date NORT„ TOWN OF NORTH ANDOVER Certificate of Occupancy $ 41 Building/Frame Permit Fee $ Foundation Permit Fee $ SAC/1u5E ✓ !A ermit Fee $ d _� Sewer Connection Fee $ Water Connection Fee $ TOTAL $ .y� Uuildingfnspector J, Div. Public Works l . �NOPTyMry 'M Y , ` KAREN H.P. NELSON r' °°m TOWOf 120 Main Street, 01645 Director '• NORTH ANDOVER (508) 682-6483 9 BUILDING .'°•�••�� .� CONSERVATION ss,°" 5` DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT CHIMNEY APPLICATION AND PERMIT DATE PERMIT # �• �,. LOCATION a11 A OWNER'S NAME BUILDER'S NAME �J i MASON'S NAME MASON' S ADDRESS MASON'S TELEPHONEOG� MATERIAL OF CHIMNEY INTERIOR CHIMNEY �,lGyi EXTERIOR CHIMNEY.®/y% NUMBER AND SIZE OF FLUES _ 2 THICKNESS OF HEARTH ,JJ� Will chimney or fireplace conform to requiremerZs of the code and have rules and regulations been received: DATE SIGNATURE OF MASON CONTR. LIC. # lG/ J� EST. CONSTRUCTION COST/CONTRACT PRICE PERMIT GRANTED E �� ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES � l - ROC-KY BR14 0-0 K HOMES Q Carroll oesiens 94301 M-RFM IN 26 X 40 COLONIAL }/s 14 X 22 FAMILY ROOM - 5 BEDROOMS - 2 1/2 BATHS - 2 CAR GARAGE UNOW r IS ME IL soon loom HE 11 A _ = = i —� = _ � - _ ■ i i ! ■■ ■0 on _ ■ - �__ ■■ ■■ on - ■■■ — __ ■■■ __ ■■ on on on on on _ ■■■ _ __ ■■■ __ ■■ SO ■■0=0 [ROME = ■■ ■■ on Job No. 94301 . � e_ ONE _'■■■�_ ❑ ■■■ _--- MIR --- Mj■■■ ONE In awl ■■■ I■■■I ■■■ ■■■I - ■■■ ■■■j on on on loom moil RUN loom son - ----- Ml 0 1 Sol" o '■. ■ � a : 1 00 • s ■■■ • • ••• • • • • •- • •- -• • .• • son ■■■ ■■■ ••• ••-• • ■■■ ■■■I. • • •- ••• • - • • • • 18'x" 14,01 f �� D E C- K COVERED PORCH N r ? - 10'6" 5'0" 24'6" - 516" 5011 210" 310" 5'1 " 12'114t" 6'43/4" so i 2 2 --J �1------- o i 2'734 n 2ro» 510" 210" 21611 j O x 1 L IN x ` LAV BREAKFAST / KITCHEN FAMILY ROOM O 2r4n O IF - N7 � cD - 00 Ln 04 3'13,4" 3,734» 513" 31611 --33/ - 21611 4 O O CD N . —T 2C14 C-4 8 310" O _ L U _ ' CO r` _ O 00 r] O c0 LIVING ROOM= FOYER _ DINING ROOM \ o 0 o :4- Lr)Ln a 2'0 3'0" 0 �o = 390" 810" 2'6" 3'6" 60011 3'6" 2'6" 810" 3'0" 14'0" 13'6" 13'0" 13161 40r0n y Drawn Job No. Dwg No. Alan Carroll 94301 FIRSI 0 Q R. P Data •, y ., '3/16" = 1'0" OCT 1994 SH 3 OF 13 40,0,. - - - - - - 14'0" 13'73/a" _ _ 6,81211 81811 - 10'113/a 11'4" 609" 6'103/4 212" 416 y21, 316" 512" - N VATH BEDROOM #3 WALK—IN a a CLOSET CD C 1 " - >r FLC-) % 2 4 216" L26 2'4" �\ - - - - - - - - - I 2'4" _ t SO _ I r - - - - - -( I : =N CLOSET CLOSET M BATH _ C2'4" 2'6" N I I I I 0 � CNI I I I 5'13/4" 5'0" 3'6" o I I I I C) -Q�, - 00 I I �- I M .BEDROOM .#1 BEDROOM 12 Ln N . a 319" 6'6" 3'3" 6'6" 6'6" 310" 6'6" 4'0" 3'6" 31611 1316" 13'0" 13'6" 316" 71011 316" 40'0" Drawn Job No. Dwg No. SECOND FLOOR PLAN Alan Carroll 94301 .. `1//16,1 _ 11n11011 a Date „� V OCT 1994 f Ski 4 ,OF 13 10 E ip 13'6" 810" _ — 6'4" 12'2" 4T 4V F - - a CV OU O BATH 00 — — — — — 2.4„ I N N BEDROOM #4 CD D N SITTING AREA ; Vaulted Ceiling I I Area 00 I - - CD 4'6" 50" 21'0,x; 5'0" 4,6., 40'0" ATTIC FLOOR PLAN 3/16 = 1'0" Drawn Job No. Dwg No. Alan Carroll 94301 t„ !v0 ,,, . Date p OCT 1994 SH 5 OF- 13 - v � ><' —... - , —_ - .mac —•. ` .. 54'0 32T 22'0" _ 12,6" 5,0„ 4'6" r ------------------------------------------ ------------------ -- ------------ ------ - t --------- - r----i - ' r---------- - ------------- '----- ------- 1 GARAGE FINISH --------------------- ----- 2 — 3 1/2" Dia. Lally Columns All Wood constructed Walls and Ceiling 1 ' With 4'6" x 2'6" Sq. x 1'0 Dp. to have 5/8 type X Fre Rated Wallboard installed I n 1 Footing (1 req d) I I 1 , 1 4'6" 6'8" %At, 6'8" 6'8" 6'8" 7'10" 712" 7'0" I o 1 co T 50 18 I10 too It 1 1 _ � _ 1 _ _ 1 _ o CD r- i ' i I -I I i I I i I of I I_ _I I i _I I oCN 1 tiGARAGE------------- 7 LT . I 4 Cicrete:Slab" ' BEAM POCKET -J_� _I Slope 1/8" per foot co :.- ''' ; 6y' W x 6)' Dp x 9" H (1 req'd) ' Shin beam with Steel Shims CD - - ► or Hard Brick 3 1/2" Dia. Lally Columns 4 Step Down into Garage (typ) 1 a ' FOUNDATION With 2'6" Sq, x 1b" Deep r----------------------------.-- ' m Footing (6 req'd) - o 10" Concrete Wall / 8'0" Pour r--------------------------- - Ln 10 Dp x 18 W Cont. Footing o �------ ---- ------- i i z -------------� UJ8 r------- ' ' -----w--------------------i ► ► i ►' �_i ► r N ' _ I - I r 13'6" 3,6" 6,0„ 3,6" 40'0" 14,0„ tooJob No. .. 94301 I Dwg W. I +I FOUNDATION.. PLAN. 3/16" = 1'0" [KSH6OF13 <, n ! „ ► Continuous Baffled Ridge Vent - - - - -2 x 12-Ridge Board 12 - - 12 CEILING 2 x 8 ® 16" O.C. ROOFING f -_ R30 Finerglass Insulation Asphalt/Fberglass Roofing �o Vapor Barrier Building Paper O° 1/2" Wallboard. 1/2" Plywood 0 2x10 ® 16 O.C. FLOOR E--10" Overhanging Soffit w/vents 3 4 Sheathing 2X10 ® 16" O.C. �N 00 FLOOR 3/4" Sheathing 2X10 ® 16" O.C. _WALL - x - - Siding, Air Barrier - Sheathing, 2 x 4.® 16" O.C. - Insulation, Vapor Barrier - FLOOR 1/2" Wallboard 3/4" Sheathing Lj r 2 X 10 ® 16" O.C. SILL 1 - 2x6P.T, 1 = 2x6KD. 3 — 2 x 12 Center Beam Continuous S11 Gasket 1/2" Dia. x 12" L . Anchor Bolts 3 1/2" Dia: Lally Columns ® ST O.C. (maxi CD With 21611 Sq x 10 :Dp Footing 00 FOUNDATION MMUNMnA PLM LDCA 10" Concrete Wall / 8'0" Pour 10" Dp x IT W Cont. Footing 4" Concrete, Slab MAIN HOUSE SECTION 3/16" = 1+0+s Drawn Job No. Dwg No. Alan Carroll 94301 Date 7 -. OCT 1994 SH 7 OF13 < ; ,� - - - Contnuous Baffled Ridge Vent - Ridge Beam ROOFING 2 x 6 Collar Ties ® 16"_O.C. - Asphalt/Fberglass Roofing- Building Paper 1/2" Plywood 12 2x10 ® 16" O.C. Q 4 R30 Insulation .12 12 10" Overhanging Soffit w/vents Nco - FLOOR . 3/4" Sheathing 2X10 ® 16" O.C. ` o WALL Siding, Air Barrier Sheathing, 2 x 4 ® 16" O.C. o Insulation, Vapor Barrier `} FLOOR 1/2" Wallboard 3/4" Sheathing SLL --_. 2X10 ® 16" CC. 1 - 2 x 6 P.T, 1 - 2 x 6 KD. - = Continuous Sill Gasket 1/2'1-Dia. x 12" L . Anchor Bolts - _ 3 - 2 x 12 Center Beam - ® gb" O.C. (max - GARAGE FINISH All Wood constructed Walls nd Ceding 0 _ to have 5/8" type 'X' Fire ated Wallboard installed 4" Concrete Slab ' SECTION THRU WING 3/16" = 1'0" Drawn Job No. Dwg No. Alan. Carroll 94301 , a Date ' a r OCT 1994 SM 8--iOF 13 - - IiII � � � � � � IIIII 2 x 1 a..(P.T.) ® 16" O.C. f -- IIII � � IIIiI 0 i 0 0 X X N N All members are 2 x 10 ® 16" O.C. Drawn Job No. Dwg No. Alan Carroll 94301 FIRST ELOOR Date 3/16" _ 1101fOCT 1994 SH 9 OF13 )A - 9 U CD . ip 0 - - 00 3 - x O J N TI= Flush Framed Beam --_ --_ Flush Framed Bea r - Drown Job No. Dwg No. Alan Carroll 94301 3 16" - 1'o" OCT 1994 I ' 9.OF 13 r e — — — — — — — — — \ \ ' Ridge Beam Flush Framed Beam Vaulted i Ceiling t s L. — — — — — —1 — — — FT __ — — L,- - - - - - - - - - - - I - - - - - - - - - - Flush Framed Beam Lower Roof All members are 2 x 10 ® 16" O.C. (UN.O.) - ATTIC- FLOOR FRAMING 3/161t = 100" Drawn Job No. Dwg No. Alan Carroll 94301 . Date A - 1 1 OCT 1994 SH 11 OF'13 I _ 1 . H . mill , 21A 12 Ridge Board J_t \ - _ All members are 2 x 10 ® 16" O.C. In—Fill Roof Framing 2 x 8 ® 16" O.C. ROOF FRAMING 3/16„ _ 1,0„ f Drawn Job No. Dwg No. Alan Carroll 94301 d Date A - 121®. y OCT 1994 Sid T2 oOF 13 1/2" Plywood - - - - Continuous Baffled Maintain 2" (min) Air space Ridge Board -- Ridge Vent �- _ 12 _ - " Air Space Roof Sheathing min.) �12 Alum. Dip Edge 1 – 2 x '6 K. D. 1 - 2x6P. T. 1 x 8 Fascia Continuous 511 Gasket with trim 1/2 Dia. x 12 L . Anchor Bolts , ® 8'0" O.C. (max 2 x 3 Nailer Soffit w/vents Roof Rafters "C' A SOFFIT 1/2, _ 1,0,o CB RIDGE VENT 1/21 — 110° . o S11 Gasket 1 – 2 x 4 Bottom Plate - or Caulk with S71 Gasket or Caulk 1 2 x 4 Bottom Platej-3/4" plywood 3/4" plywood 2 x 10 Rim Joist o 0 2 – 2 x 4. Top Plate 2x10@16" O7JOil3t o ` L2 Floor Joists 2 – 2 x 10 Rim2 - 2 x 4 Top C) INTERM. FLOOR , 1/2" - 1'0 D INTERM. FLOOR 12" _ 1,p, 4" Concrete SlabQ o - o ' o� Gasket or Caulk FOUNDATION CONSTRUCTION 3/4" Plywood 10" Concrete Wall / 8'0" Pour 2 x 10 ® 16" O.C. 10" Dp x-1'8" W Cont. Footing p Job No. . � 9430 1 1 - 2x6P1.:T.. 1 - 2x6KD. s o Continuous Sill Gasket Dwq No. 1/2" Dia x 12' L . Anchor Bolts 8'0" O.C. (max - A - 13 10" Conc. Fdn 10 CONC. FDN. ., SH 13 OF 13 LE SILL 4 �o . 1i 2 = .� W . ,�2., _ ,.�., CERTIFICATE OF USE & OCCUPANCY. �1���,�,q�� tak'�' s,'t Town of North Andover aa _ � ijq��t�ei�� l �'gy ,llr tr , it�13 . : — �"�� `�����a {s�f.�,�� ������,z +�j��t'��tt��A"',r9�. ;��''i�•3,alg�:, ;� o, f i It q4 4 '4 z Date =.Building Permit Numb®r - 8 M lel S �{ � t � y t" k? ,'}♦ ^7 Ji 7 I i 3 1 f`1I1 I¢.1 ? Dirk I{{ H }�.3ikk r' I 1 to i1 d ;�� � 2.r'�'h :•Y4> }� s � � s � a .I;�e�ii :y.r )- 4 � ? 1� - #� I S� .�, y.. 4 p}rt.� :r 'i• yy9.�#� :I � ,:V i. �'. :Ep:hil ,u' �y: I� "? oFit i ;fpg : .t: ,a' r�'!�'a•t 7�xrG�7a7'3S1 s,N7:{}�`�.:,�'t�T��III 'fr?i`W�' t«is�}y...91� �il'�i�• .,:4 ,ft � ,r)q i a�iq {i9'f�l) � }�: -'' ;!I! { THIS CERTIFIES THAT 1lii'' Iak ;i. • h""t , iI i I 1 : f�rfl}�Ft����� t����i�,.��'��'�t � -,I") r • � a JHE BUILDING'LOCATED � c_ r : ,�) "Q� 3y•.I.� t { F f4 I It.k�l �QII �r�'1i4. LOCATED ON I 'ta' all��)����)e}�.��5 ��,, f • tr $� E d;«: �":', .. .). '�t a �s'.� { �j tl�, 'BE OCCUPIED 61.E.. Ml �l4 IN ACCORDANCE. g �..- P �. . .,WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND: SUCH OTHER REGULATIONS AS MAY APPLY. , y f 6 o',.'•e i, ao CERTIFICATE ISSUED TO OGKt�►�2rOC1� Cri111..� r ;; jt y)t� at bd I �:RaYI: ` 3� ��lf• ..��..• O i a �.t p s3 {s;r '.� - d; iln �1�ia� !F7 o �C• '; _ .':l"1 b �O�CI�R.'ta � N I ADDn. n i { ff { iq . .. .9�. r F � r*il-�3 � � .���Pi Sq �.ra.i.3 �,� i x { + ``I • NUS ,/i g �t5 t JACjly i P I d ��7 i - i •�..tr n i •;' E.k ;� ! 'Jq 9^i t �.IiL$y¢ I,�aI Y: `�i' � ri' tz y�%I' -'} i y }.i. � �'y..),. Y+' .�i'�t {4{) �l, tl�•:y �,xs H {�: U• E .i'� sl. �si: �{GG 5' :�'. [�I ..t is �� � I h; $a �,i�d .,� �+LI 1..,,L I h. '� il': 4 s, •�1F Wi I .I I ..i11 "f£. }. .1°. I. .. ,F.•, ^ I) i.!f +� •.p: F 071 �). 'a i "' �- �" § ��''P j•rjx+�� � �!�7 1� Ir�t :+ �; ± t%� !ti "a r.�'s:., s � .. 1:_a � I � ..,t�rl�:h. 4°„a_„ .,�.".t.,Ni � INN qqt W #�yy�s rl�l 1+ • I sg� t {, rtl lirrli a)a� ty tf 1.i - � - 1 ,q i x , 4 �Ir , I 0VM Of � ®ver No \� O r e, t, • '4Br � �. Zort dover, Mass., 2-8 19 j LAKE 44 A COC HIC IC KE WICK V AORATED E BOARD OF HEALTH Food/Kitchen Septic SystemPERMI BUILDING INSPECTOR ' n�,,� THISCERTIFIES THAT.. C��...N �•................. ....�.�..................................................................................... Foundation has permission to erect .tAW � co �ug, t . k •••• to be occupied as QAEAJL. r�1A'll. !M�..-.. �4�,,. Q ....4 11► ....... Clin, eye' fti provided that the person accepting this pe�mit shall In every respect conform to the terms of the application on file In I 'this office, and to the provisions of the Codes and By-Laws relating to the Inspectsqp,��,�t� A Buildings In the Town of North Andover. °'f' 1"ABUNRLCULATED BY PARA." 114.8-SIUro IINL B.0 PLUMBING 7 INSP R " . VIOLATION of the Zoning or Building Regulations Voids this Permit. nle 07 FEE PAI (96A GA PERMIT EXPIRES IN 6 MOK I'HI ; ELECTR AL IVSP c UNLESS CONS ST RDu y'�s , PERMIT FOR FRAME/BUILDING BUILDING INSPECTOR DATE: FEE PAID• d1 ' d ► �/� Occupancy Permit Required to Occupy Building GAS INSPECTOR' ,. Display in a Conspicuous Place on the Premises Do Not Remove I:�uRt' p Y p Final jr L No Lathing or Dry Wall To Be Done FIR : DEPARTMENT Until Inspected and Approved b the Building Inspector. Burner b . 0 . t 3�q I i Street No,C " L v PLANNING FINAL CONSERVATIO l �YPT1- _ �"}�- yxrN Smoke Det. "�• �,� SEWER/WATER 2216d FINAL DRIVEWAY EN RY PERMIT `'T � 1 N2 2655 Date.....w..� ...�Jv. P .;t � NORTM 1 3?°•t `"-. "�O� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING SSAC14USE� This certifies that ........ ....... (.`).................. I �GS��.���� y Cti�� has permission to perform .........................i.....1.................:....:�....................... wiring in the building of......... U.. ..!..................................................... at J.....ct!..... ck`: ..�!s .t1 v ...... ,,North Andover,Masse-, f Fee.... .S�: Iv Lic.No....., � �'......... ��LECTRICALINSPECTOR Check # " d v WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Convnonurf ,� , -V, "&cA&W a! For Office UseOnly Permit Number: So✓ �i,JfParwYAi O�JLIf�flVECfd BOARD OF FIRE PREVENTION REGULATIONS Occupancy 8 Fee APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00) PLEASE PRINT IN I�NppK''OR TYPE ALL INFORMATION Date: dv City or Town of: NO& 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) J &ZOOK Owner or Tenant: //� loa_ Owner's Address: c7 Is this permit in conjunction with a Building Permit? Yes ZINO o (Check Appropriate Box) Purpose of Building: �! Utility Authorization#: Existing Service: Amps / Volts Overhead ❑ Underground.❑ #of Meters New Service: Amps / Volts Overhead ❑ Underground.❑ #of Meters: l r, Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: No.of Recessed Fixtures tiNo.of Ceil.-Susp.(Paddle)Fans No. of Transformers Total KVA No.Of Lighting Outlets No..of Hot Tubs Generators KVA No. of Lighting Fixtures �» Swimming Pool: Above ground o In Ground a #of Emergency Lighting Battery Units No.of Receptacle'Outlets No. of Oil Burners Fire Alarms #of Zones #of Detection&Initiating Devices No.of Switches No.of Gas Burners #of Sounding Devices: _ #of Self Contained No.of Ranges No. of Air Conditioners TOTAL TONS: Detection/Sounding Devices Local o Municipal Connection o Other o No. of Waste Disposals Heat Pump Totals: Security Systems: Number: TONS: KW: No.of Devices or Equivalent No.of Dishwashers Space/Area Heating: KW Data Wiring,No.of Devices or Equivalent: No.of Dryers Heating Appliances KW Telecommunications Wiring:No of Devices or Equivalent: No. of Water Heaters KW No. of Signs: #of Ballasts: OTHER; #of Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE:Unless waived by the owner,no permit f the performance of electrical work may issue unless the licensee provides proof of liability insurance including'completed operation'coverage or its substantial equiv nt. The undersigned certifies that such coverage is in fo�rcee and 'has /e �ibdited proof of same to the permit issuing office. CHECK ONE: INSU BOND ❑ OTHER ❑ Please specify: Estimated Value of Electrical Work _ (When required by municipal policy) Work to Start: '3 Inspections to be requested in accordance with MEC Rule 10,and upon completion. c rtlfy,/oder the pains and penalties/of perjuryy,that the Information on this application Is true and complete. /) Firm Name: V L L/�C )-,el/C D -�/'�G LIC.# �'7 5? 3-3: Licensee: S. /%. .Tv/�l� J� Signature: LIC.# 3 3 Address: 5F-96-//CA;�E121/J/ (if applicable,/e�n�ter" empt"In the Il nse num r line) 0S, A4 Uiy�Bus.Tel.# 4:T - Alt.Tel.# 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❑ OR Agent a Signature of Owner/Agent: Telephone# PERMIT FEE:5 r( Location No. 3 C:;2, Date NORTIy TOWN OF NORTH ANDOVER % Certificate of Occupancy $ �ss�cMust� Building/Frame Permit Fee $ I14 '" Foundation Permit Fee $ ky Other Permit Fee $ _ TOTAL $ " Check # 14 Building Inspector w � t � TOWN OF NORTH ANDOVER _ BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE I71! /� ` c6t,�� ic SIGNATURE: Building Commissioner/Inspector of Buildings in Date SECTION I-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 4Vl Zoning District Proposed Use I of Area Fronts e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re aired Provided 1.5. blood Zone Infonnatioa: 1.7 Water Supply M.G.L.C.40. 54).� " '-� 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT -- 2.1 Owner of Record RCk. Namet Address for Service r 2 S1 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O ' t � Signature Telephone j M .SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor:. Not Applicable ❑ iLicensed Construction Supervisor: License Number mn Address r� / fC—�, Z �1S �� Expira on D to Si ature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name m Registration Number I... Address r tI � �t� 6k Expirationn Date ^ -Signature Tele hone 11/ -3�'p c7 t A � f r - SECTION 4-WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work check appiicable New Construction ❑ Existing Building, Repair(s) ❑ Alterations(s). , Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief scription of Proposed Work: f �3c� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be :" OFFICIAL USE ONLY Comp leted by permit applicant. = 1. Building (a) Building Permit Fee Multiplier 2 Electrical f (b) Estimated Total Cost of c!UCX� Construction 3 Plumbing Building Permit fee(a) r (b) 4 Mechanical(HVAC � 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHOR TION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, wt as Owner/Authorized Agent of subject property Hereby authorize to act on My bel tin all to rs relative to work authorized by this building permit application. Si na Cit Date SECTION 7b`O_WNER/AUTHORIZED AGENT DECLARATION ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief \^ i Print Nanw �- s a�� C.C' Si ature of r/A en Date wn Y. NO. OF STORIES SIZE ' 4' BASEMENT OR SLAB SIZE OF FLOOR TINMERS iST2ND 3 RD SPAN. DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHR NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ✓�ie i�omvrreo�uuea�� a�✓�aasac/z+�aP,/.�a BOARD OF BUILDING REGULATIONS f License: CONSTRUCTION SUPERVISOR I Number. CS 028538 Birthdate:09/05/1948 I Expires:0910512001 Tr.no: 4729 Restricted To: 00 MICHAEL V RODDEN 47 PRESCOTT ST ""'`'. .. N ANDOVER, MA 01845 Administrator �/ee'Piovwrn��,/,p�.o�,�ac�uaeCGt . HOME IMPROVEMENT CONTRACTOR I Re istr 9 atio6 105903 Type - YP INDIVIDUAL -Ul Expiration r P ation .07121100 21/00 MICHAEL V. RODDEN Prescott Street ADMINISTRATOR Andover MA 01845 - v Town of North Andover NaR7h Building Department 0 27 Charles Street North Andover, Massachusetts 01845 1 .^ (978) 688-9545 Fax (978) 688-9542 a4 `°` ~�• �` �9SSACHUS���� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Faci y location Signature of Applicant ?< �v Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. aI 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. Com an name: GY1 V Address 1 4? City \�1y`� �`�.� � �.` Phone#- `7� ` �a Z`f 3 Insurance Co.-CL-Cl C) P Oligy# a u �32)4,C KL4 I<q 5'Ub Company name: Address City Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I n m forwarded to the Office of Investigations of the DIA for coverage verification. understand that a c of this statement a be orward copy Y 1 do herby certify under the pains and pen s o ' ry that the information provided above is true and correct. Signature �- Date " 0 �/ Print name Phone liqlD O 7 ` Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check d immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION FORM - U - LOT RELEASE FORM I INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT PHONi:� ASSESSORS MAP NUMBER J LOT NUMBER SUBDIVISION LOT NUMBER I STREET 1�uLy` ' \c�'� �C� STREET NUMBER �................ . ........................................................ OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS qS ,f VA DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS i DA'IL APPROVED I TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED a.s -S C MPECTOR-HEALTH DATE REJECTED COMMENTSS •�r�-�-r� A� may,v.�.. �j., Or /� � / � e'a Z3•�►- � . °�S .d�5��1i*.�°� {�,=-�sl,h'J.�'"^�'� /' �/°'?n�Y ��� /�✓��.6J�+ er-'��C��"�C�:e"''�,_ PUBLIC WORKS'-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE _.. --=.. NORTH s 01VM .' ® - 4 fdover 0 No. 43a 1.00 o = L A ® lover, ?Mass., COCHICHEWICK AORA-rED S H y BOARD OF HEALTH PERMI i T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....7A1.4-C........RgP.W.!g.//�,b � �� ..... .. � Foundation has permission to erect....�I...............0.... buildings on .... ..... ....... ................... ...... Rough p t® he occupied as........A3..* .�.:* ..................................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and,By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. /V P4& OMMI. PLUMBING INSPECTOR • VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PE�11VJlg A EXPMES 11V 6 MONTHSELECTRICALELEC'T'RICAL INSPECTOR UNLESS CONSTRUC N ST _ Rough .. ..... ......... ...... ......... ........................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in. a Conspicuous Place on the Premises ® Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 54'0" 1 n 32 0 ` 22'0" 12'6" 50" 4'6" r ------1.11 1 rp --------------------------- - o t F ► -- --` '' GARAGE FINISH ; I I /1 ' All Wood constructed Walls and Ceiling 2 — 3 1/ is L lfy Col mns. n , , , With 4':' x 2'6" q..x " Dp. to have 5/8 type X Fre Rated , I �, Wallboard installed 1 Foo ' g (1re d) 11 0 � I Q, " 618" 61811 6' 7'10" 712" 7'0" o I , Co 510n 8n I o �► z a CD C14 CN GARAGE9-1 I 4" Concrete Slab BEAM POD > Co \ Slope 1/8" per foot 6 W x 6" Dp x H (lre I ; o Shim beam wit teel S Ims I ' or Hard Brick 'i 4 4"Step Down into.Garage (typ.) ; I o 1/2 Dia. II of ns , I m FOUNDATIO With 2'6" 1'0" eep r---------------------------- 2.1-- - - Footin req d) - � 10" Concrete a / 8'0 Pour r--------------------------- 10" Dpx1'8" 1 o ________________ ------- ---__ ------ J N 1 1 1 13'6" 3)6" 6,0,1 316" I 13'6" 40'0" JI' I 140" Job No. { 94301 lowg No. - FOUNDATION PLAN, A 6 3/16 - 10 ti SH6OF13 14'0" - D E C K COVERED PORCH 00 N -- - 10'6" 5'0" - 24'6" � --SGrrrG�'►� 516" 5'0" 210"1-1- 3'0" 5'1't 12'11 " 643/4" 1q, 2 2 2 210" 5'0" 21011216 LAV BREAKFAST KITCHEN 2,4" L FAMILY ROOM o 00 Ln CO N 31r34 ! n r n r3n 31611 �- 37 3 4 5 � 2'6" O ---- — ---_----- — — — c0 LO CNN CN 0 2'8" 310" N f\ co N] cV O dp 00 _ c0 p r CD LIVING ROOM, = FOYER DINING ROOM 3ycz) (' o . o 2'0 310" 2'0 =N 00 CL. CL. 4'O" 6'O" 4'0" 3'0" 800" 12'6H 3'6" 610" 316" 216" 8'0'r 3'0" 1490" 13'6" 1310" 1316» 40'0" Drawn Job No. Dwg No. a - Alan Carroll 94301 FIRSOR PLAN Date - 3 OCT 1994 SH 3 OF 13 40'0" 14'0" - _ 13'73/4, 6'81/2,� = 8'8" 10'113/4" 114" 218.1 6�9" 6'103/4„ 2'2" 4'6y2„ 316" 51201 - I _ o O - BEDROOM #3 ATH WALK`iN a a o - CLOSET 2,4„ LO ElY ' 2'4" CLOSET CLOSETSO cc ► ; —( I N - N N I ; M BATH 2'4" 2'6" I o ^ N I I I 0 FLO N 5'13/4 510,E 316„ I I I I - o I I I cp 00 I0,3 _ M ;BEDROOM #1 BEDROOM 12 N 2011 N 319„ 6'6" 313,E 6,6„ 616,p S0" 616,E 4,0„ 3,6" 3,6„ 13'6" 13'0" 13'6" 316,1 710" 316„ 4010" 14'0" SECOND FLOOR PLAN Aia Job No. DwgNo. n, , „ n Carroll 94301 3/16 = 0 Date I A OCT 1994 SH 4 OF 13 - _ - - 13'6" 81611 _ 614„ 1212" _ 416" 416" 0 CN i .. O I So BATH fx � 1 - I - - - - - - - - - - co — — — — — 214" — � � I C%4 CD BEDROOM #4 D N SITTING AREA i Vaulted 6NL� I ceiling I I Area I I 00 CO 4'6" 5'0" Poll " H I 46 50 21501 416 40'6 U I - ATTIC F LtUP! A"J 3/16" Drawn Job No. Dwg No. U Alan Carroll 94301 Date A - 5 OCT 1994 SH 5 OF 13