HomeMy WebLinkAboutMiscellaneous - 622 SALEM STREET 4/30/2018 i
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'I
Locations
No. ( Date
NORTh TOWN OF NORTH ANDOVER
O
� 9
` Certificate of Occupancy $ -
,'�sJ' •Et� Building/Frame Permit Fee $
�CMUS
s
Foundation Permit Fee $
ti J
Other Permit Fee $
TOTAL $
i'
Check # /7 �f
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1 O { 3 r ```-Building Inspecl19'
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPL?ICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER. DATE ISSUED. �
SIGNATURE:
Building Commissions /I for of Bu' &gs( Date Z
SECTION 1-SITE INFORMATION ' IO
� �`Toperty Address: 1.2 Assessors Map and Parcel Number:
__ ul e✓•, s i p 11
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Fronto ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
3-3 20 z`/ o -3 o c)
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public % Private ❑ Zone Outside Flood Zone Municipal .I On Site Disposal System ❑ J
SECT O 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT IC : es o rn
2.1 Owner of Record
S
Sa"i r`e e
Na nt) Address for Service:
Signature Telephone
a
2.2 Owner of Record:
Name Print Address for Service:
Signature Tele hone 90
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: S _06313J
_ License Number 11
A@hess
t)...� a �) - el S' 9,IY6 Expiration Date
Si ature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name M
Registration Number r
Address
z
Expiration Date Q
Signature Telephone
F
SECTION 4-WORKERS COMPENSATION(M G.L.C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes......M., No.......❑
SECTION 5 Des tion of Proposed Work check all a licable
Repair(s) ❑ Alterations(s) ❑ Addition
New Construction Existing Building ❑ ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
k
SECTION 6-ESTIMATED CONSTRUCTION COSTS .77
Item Estimated Cost(Dollar)to
completed by e a licant -" -
1. Building (a) Building Permit Fee~
S^ U Multi lier
2 Electrical (b) Estimated Total Cost of
O- v uConstruction
Building Permit fee (b)
3 Plumbina j
/
4 Mechanical HVAC -
5 Fire Protection N-
6 Total 1+2+3+4+5 2 1,5-/trz&v Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
to act on
Hereby authorize
My behalf,in all matters relative to work authorized by this building pernnit application.
Si ture of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I ` STS `,6 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
00
Pr'_ e
6-3�-cry
Si ature of Owne /Agent Date r
NO.OF STORIES SIZE Z$566
t
BASEMENT OR SLAB 2 3 /✓`/�
SIZE OF FLOOR THVIBERS I
NOF
ONS OF SILLS
IONS OF POSTS tl l ^
IONS OF GIRDERS 'L X N2 THICKNESS
OF FOUNDATION '
FOOTINGX `�AL.OF CHEANEY
ING ON SOLID OR FILLED LANDING CONNECTED TO NATURAL GAS LINE T et'
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
r Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance.with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
l
APPLICANT '�L�.-•��Y C! 1� PHONE q-)9%kl
LOCATION: Assessor's Map Number PARCEL �\
SUBDIVISION ��, . .. LOT (S) t-_L
STREET ST. NUMBER ,Aa
*************** **********OFFICIAL USE ONLY
RECO NDATIOS PFJOWN AGENTS:
CONSERVATION A INISTRA R DAT
TE EJECTED
COMMENTS A4,S4- e- - co w ®`+��� -,oies, 12,r.v 'W VA
At-
�i U%
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS -SEWER/WATER CONNECTIONS
DRIVE AY PERMIT -l¢-Z}�
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECT DATE
Revised 9197 jm
1
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11, S150A.
The debris will be disposed of in:
( ocation.of Facility)
ignature of Permit Applicant
-o/oV
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
s
a The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
Boston, Mass. 02911
Workers'Compensation Insurance Affidavit
Name Please Print
Name: �tq
Location S � nl� o
�• �..�..,ir/ t8�1�
CityJ`� Phone # e17�'
I am a homeowner performing all work myself.
I 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.
E-1
Company name:
Address
City Phone#:
Insurance Co. Policv#
Company name:
i
Address
Cily: 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.penaltiesfnfhefnrmd-a_STOP WORK ORDER..and..a.fine.of.($1.00.00)_aiday-against-me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herebythe Ipenalties4Ps4mw.Uzat the information provided above is true and correct.
Signature Date 640 -0 `j
Print name E&W nt'P Phone# 7Z,- $`ts- `iyZlFa
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
0 Building Dept
❑Check if immediate response is required E] Licensing Board
r-1 Selectman's Office
Contact person: Phone#: Health Department
0 Other
GROWTHMANAGEMENT BYLAW EXEMPTION STATEMENT
TOWN OF NORTH ANDOVERBUIT.DING DEPARTMENT
This=form,shall be-used to-assist the Building Department in their determination of exemption under section #
8.7.6 of the Townof North Andover Growth Management Bylaw. The applicant;shallprovide all of the .
necessary;information as requested below.
Permit Applicant Property address Map/Parcel
Apphcani's Phone Number Single FaamilyTwo Family
-. t
I the undersigned applicant for the above property.attest that the attached building permit.for which,this form is compacted
does comply with the EXEMPTION section 8:7,6 of the Growth Management Bylaw:I also understand piovidingthis foridoes not
Yabsolve me or:any party to'this permit from the requirements of obtaining other permits required prior to the`issuance'ofthe building ,
permit.Furtherl understand that my interpretation'ofthe exemption status is subject to ieview by the'Builduig Department and is only
officially accepted when the building permit is issued.
Based on section 8.7.6 of the North Andover Growth'Bylaw the above lot and the work as applied for on the above lot in the building '
E permit application:and associated attachments complies with one or of the following sections as i idicated by a check mark.
-This is an application for a building permit for the enlargement,restoration or,reconstruction of a dwelling in existence as `
R ofthe effective date ofthis bylaw,provided that no additional.resdential unit is created,,
-Tbe lot(s)was/were created prior to May 6,1996 and are exempt-from the provisions of section,.8.7 ofthe Zoning�Bylaw.
s ,
This application is for dwelling units for low and or moderate income families or mdiViduais where all of the conditions a A
of 8.7.6 are met and.or mpresetitsAwclling units for senior.residetts;where occupancy of the units-is restricted to'senior citizats'
through a properly executed and recorded deed restriction running with the land.For purposes of this sectiom"senior shall mean �-
persons over the age of 55. 3^ d l
a t a i
This application-is part of development project,which'voluntarily agreed to-a minunum'40.%o permanent reduction in t
r. density(buildable lots)below the density permitted under zoning and feasible given the environmental'conditions of the tract,with the', 4
1 surplus land equa(io at least ten buildable aeies and permanently designated as open space or farmland:The,land-to be preserved shall .
be rotected from development b an A
p op y gricuttural Preservation Res ction,Con§ervaiion Restriction;dedication to the Town;or other;
similar mechanism approved bythe planning board that wt ensure its protection. "•
µ
This application represents a tract of land existm and riot held b
g y a Devel oper.in common ownership with an adjacent
parcel on the effective date of this.Section 8.7 and shall receive'a one time exemption from the Planned'Growth Rate and:
l "
Develo merit Schedulin revisions for thepurpose of oonstiuctin one sin a famil dwellin unit on the parcel. .
P g P g single Y g W
This application represents a lot which is'ready foi a building permit'(all other permits from all other boards and t
commissions have been received and the project is in compliancewith those permits),and the Development Schedule does not ` T
` accommodate issuing a building permit in that ear.One building r
Y gperm$will be issued per yearpec Development until such time as t p.
the development schedule accommodates issuing building permits;Applicant must submit an.approvedFORM U with this 3 >-
EXEMPTION. x
PLEASE PROVIDE-ANY AND ALL INFORMATION THAT WOULD,ASSISTTHE BUILDING DEPARTMENT IN MAKING A; p...
r
DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS.
BY.SIGNING BELOW I ATTEST:TO THE�ACCURACY'OF;THE-INFORMATION PROVIDED AND=THAT THE ATTACHED t
F ...••. - - y W
f. BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED'ABOVE: r
FURTHER I UNDERSTAND THAT.THE SUBMITTAL OF MISLEADING OR.INACCURATE INFORMATION OR THE
CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT.COMPLY;WHETHER DONE TO MY KNOWLEDGE OR
NO S OR AL BY THE BUILDING DEPARTN ENT TO ISSUE A BUILDING'PERMIT.oe '
APPLItANTS SIGNATURE°
,. DATE
THIS FORM TO BE,ATTACHED TO THE BUILDING PERMIT APPLICATION
NIF luL.r o, zvvz �-
ILD J. LEDUC &
'LIE M. LEDUC 3' i B-9
DK 5167 PAGE 83
PLAN #7140
IAP 38 LOT 114 B-8 .
N � B-12
B-10
o B-11
�+ B-13
LOT 11 - 1
� B-14
LOT 11 -2
TOTAL CBA = 100X
AREA = 37,375 SQ.FT.& OR TOTAL CBA = 100N B-1s
0.8580 ACRES AREA = 139,641 SQ.FT.& OR
TOTAL LOT WIDTH N 3.2057 ACRES
157.65' TOTAL LOT WIDTH
EXISTING 17.3. 18' 1�
DWELLING ,�
• fx�'
59
W4 _ 65.02' /
82 75
_ TOTAL
& '3°'6° FRONTAGE = 149.39'
,,W N71'26'03"W
o� rn 1 05 �A►L a•7,6y N85'0 572 57.59'
- Rp�1P 116.54, E.C.S.B./L.P. E.P 14.26'
DRILL HOLE � a� F 28.33 FOUND N56'54'14"W
FOUND / \ 56 N85'08'32"W ry
580.E
69 _ /
TOTAL 7.40'19„W S�\ /
F JL
NS E.C.S.B./L.P. E.P3000)
2.78' FOUND-* � VARIES E.C.
N87'40'19"W �ai18EIC N WIDTH
-.
.t
Permit Number
REScheck Compliance Certificate Checked By/Date
Massachusetts Energy Code
REScheckSoftware Version 3.5 Release 1
Data filename:Untitled.rck
TITLE:Lot 11-2 Salem St N Andover
CITY:Andover
STATE:Massachusetts
HDD: 6322
CONSTRUCTION TYPE: 1 or 2 Family,Detached
HEATING SYSTEM TYPE:Other(Non-Electric Resistance)
DATE:09/30/04
DATE OF PLANS: 11/24/94
PROJECT INFORMATION:
PJS Realty
87 Church St
Merrimac MA 01860
COMPANY INFORMATION:
J&J Heating&Air Cond
17 Arlington St
Dracut MA 01826
COMPLIANCE:Passes
Maximum UA=610
Your Home UA=559
8.4%Better Than Code(UA)
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value U-Factor UA
Ceiling 1:Flat Ceiling or Scissor Truss 1864 30.0 0.0 65
Wall 1:Wood Frame, 16"o.c. 2994 13.0 0.0 198
Window 1:Vinyl Frame:Double Pane 544 0.350 190
Door 1: Solid 39 0.460 18
Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 1864 19.0 0.0 88
Furnace 1:Forced Hot Air,93 AFUE
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,specifications,
and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts
Energy Code requirements in RES checkVersion 3.5 Release 1 (formerly MECchec4 and to comply with the mandatory
requirements listed in the RES checklnspection Checklist.
The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design
i
Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the
design load as specified in Sections 780CMR 1310 and AA
Build signer Date
1
I
i
REScheck Inspection Checklist
Massaehusetts Energy Code
RES checkSoftware Version 3.5 Release 1
DATE:09/30/04
TITLE:Lot 11-2 Salem St N Andover
Bldg.
Dept.
Use
Ceilings:
[ ] 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation
Comments:
i
Above-Grade Walls:
[ ] I 1. Wall 1:Wood Frame, 16"o.c.,R-13.0 cavity insulation
Comments:
I
Windows:
[ ] I 1. Window 1:Vinyl Frame:Double Pane,U-factor:0.350
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes[ ]No
Comments:
Doors:
[ ] I 1. Door 1: Solid,U-factor:0.460
Comments:
I
Floors:
[ ] I 1. Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-19.0 cavity insulation
Comments:
I
Heating and Cooling Equipment:
[ ] I 1. Furnace 1:Forced Hot Air,93 AFUE or higher
Make and Model Number
I
Air Leakage:
[ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air
leakage must be sealed.
[ ] When installed in the building envelope,recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture
and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944
L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled.
I
Vapor Retarder:
[ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors.
I
Materials Identification:
[ J I Materials and equipment must be identified so that compliance can be determined.
[ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating
equipment must be provided.
'
Insulation R-values,glazing U-factors and heating equipment efficiency must be clearly marked on
the building plans or specifications.
I '
{ Duct Insulation:
[ ] { Ducts shall be insulated per Table]4.4.7.1.
{ Duct Construction:
[ ] { All accessible joints,seams,and connections of supply and return ductwork located outside
conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed
{ using mastic and fibrous backing tape installed according to the manufacturer's installation
{ instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted.
[ ] { The HVAC system must provide a means for balancing air and water systems.
{ Temperature Controls:
[ ] { Thermostats are required for each separate HVAC system. A manual or automatic means to
{ partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided.
I
{ Heating and Cooling Equipment Sizing:
[ ] { Rated output capacity of the heating/cooling system is not greater than 125%of the design load as
specified in Sections 780CMR 1310 and 34.4.
I
{ Circulating Hot Water Systems:
[ ] { Insulate circulating hot water pipes to the levels in Table 1.
I
Swimming Pools:
[ ] { All heated swimming pools must have an on/off heater switch and require a cover unless over 20%
{ of the heating energy is from non-depletable sources. Pool pumps require a time clock.
I
{ Heating and Cooling Piping Insulation:
[ ] { HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the
levels in Table 2.
Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes.
• Insulation Thickness in Inches by Pipe Sizes
Heated Water Non-Circulating Runouts Circulating Mains and Runouts
Temperature(F) Up to 1„ Up to 1.25" 1.5"to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
Piping System Types Range F 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0
Low Temperature 120-200 0.5 1.0 1.0 1.5
Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0
Cooling Systems
Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0
and Brine Below 40 1.0 1.0 1.5 1.5
NOTES TO FIELD (Building Department Use Only)
RTH
own ® � 4Andover
0
No. Al OZ
S Syy �, Ido dover, Mass., 7A0 d
T Q Z_- LAKE
If, CO.0 HIC ME WICK V
A0RATED P'PCC5
SSA HUSH
P T .
FOR
EXCAVATION AND FOUNDATION
so
THIS CERTIFIES THAT ... P'..VT... .............. 8 ... ......9... Q4 ................................................
��JeQ tQ sAl� s�
has permission to excavate and pour foundation at ................................................................. ....... .............
for the purpose of 10 Room,,10lk 8�4'M ,a S ra)�. -.�1� ................ I........................................
l �r �
PP ......... ....... .... ..
The person accepting this permit must return to the office of the Building Inspector a certified plot plan show
of building thereon before Foundation will be inspected.
VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS
The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS
assurance that a permit for entire building structure will be granted.
SEE REVERSE SIDE00 00 .. ........................ R
BUILDING INSPECTOR
NORTH
'9
o ; of
0
1L. = A. dover, Mass.,—/02 —/7—010 O v,
11' COC. ...WICK
RATE D PP �5
IT BOARD OF HEALTH
Food/Kitchen
..PERMIT T D Septic System
THIS CERTIFIES THAT
�� S Q� / y BUILDING INSPECTOR
J..... . .. .....
Foundation
has permission to erect.......... g .191/N �4dA Q S a 4ION S
......... ..�....... buildin son ... ..... ...................... Rough
. ................................. ..
to be occupied as Roo M►1 a 11 l3 Th S �// �,v�!/` S�.Y �t •S/
p (................................... .. ............................................................ ......... imney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in
this office, and to the provisions of the Codes and By-Laws relating to the Insction, Alteration and Construction of Final
Buildings in the Town of North Andover. L / PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMEXPIRES IN 6 MONTHS Final
IT
UNLESS CONSTRUCTI �S � S ELECTRICAL INSPECTOR
Rough
......... ....... .. .. ......... .. ....................... Service
WING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT
Burner
Street No.
SEE REVERSE SIDE Smoke Det.
Location
i No. Date
f
6
NORTH TOWN OF NORTH ANDOVER
F R
9
Certificate of Occupancy $
. �� ,• , c O
��s'•^°'
cNEta' Building/Frame Permit Fee $
Jwus
Foundation Permit Fee $
Other Permit Fee $
k TOTAL $
Check #
18533 /lt �
Building Inspector
Safety Insurance
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectman
City Hall City Hall
NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845
RE: Insured: TERESA SWIMM and DAVID SWIMM
Property Address: 622 SALEM ST,NORTH ANDOVER, MA
Policy Number: HMA 0345000
Claim Number: BOS00031421
Date of Loss: 8/16/2012
Company: Safety Property and Casualty Insurance Company
Claim has been made involving loss, damage or destruction of the above-captioned property,
which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be
applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate,please
direct it to the attention of the writer and include a reference to the captioned insured, location,
policy number, date of loss and claim number.
k
William Jones Claim Examiner - 8/20/2012
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3461
Fax: (617) 531-2767
Email: WilliamJones@Safetylnsurance.com
11W230V-10-60 Hertz Power Supply
(G� L1 L2 N For 115V, Use Terminals Ll L N, And Connect A Jumper From L2 to N
r'CB 1 M1
Tl . / PUMP
T2 MTR.
CONTROL POWER .. tIIZJ
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--7 ❑N-OFF .
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FUSE
C3amp) _ H
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BRN MI. d
OF F RED/WHT Ml
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--� -- SILENCE j
LS 3
(HIGH LEVEL)i SR Via 14 SR 13
L---z ---� g [SRO
5 AUDIBLE ALARM H
SR T
VIO/WHT
_
OPTIONAL DIFFERENTIAL PRESSURE SWITCH OR WIDE-ANGLE FLOAT
= IF USING SEPARATE POWER SUPPLY FOR ALARM, REMOVE JUMPER FROM
TERMINAL J TO AL1 AND CONNECT 115V ALARM POWER SUPPLY HOT WIRE
TO TERMINAL AL1 AND GROUNDED NEUTRAL TO TERMINAL N, (15amp MAX,)
Ll N 1 ! f 4 J 5
T T T T
I LTJ4
Notesi DRWN. DATE 220 Ohio S treet
1)Level Switches Must Be Rated a Min. of 2 Ams 1! 120 volts.
P Ashland, Ohio
.2)Pnnel Main Disconnect Must Be Provided Installer. ARW 3/15/04 (419)2®1-5767
,)Torque 3/8' fleld wiring terminals toB In.Lbs.
J)Torque 1/2 field wiring terminals to 25 In.Lbs. CHKD. DATE SCALE DRWG, NO,
4)Fleld Wiring Must Be 60'C Copper Wire Minimum. qq
5)------= Items Not Supplied In Control Panel. NONE f-1—S M 7 0 L S E t
i
Date./�-'.
<N`O°T:��o I Vrll OF NORTH ANDOVER
3: c�
PERMIT FOR PLUMBING
,SSACNUSE�
This certifies that' .t . . .- . .� . .
has permission to perform .�/—. .``� . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of A _r: ...... . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . .
at
. . . . .. . . . , North Andover, Mass.
Fee'?f7. . . Lic. No. ,r c . . . . . . . . . . . . .
_ PL4IMBING INSPECTOR
Check # Gj23
6704
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I
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i
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
I ?_'- t -
Building Location(,,tea �Q , Owners Name Date t ZC;c�
QJ� ����1- Permit#
I Amount 9
Type of Occupancy
I
New ® Renovation i Replacement 13 Plans Submitted Yes 0 No 13
i FIXTURES
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7M HfM
L 9MIMM I I 7-1-LEE I I
(Print or type) I Check one: Certificate
a Installing Company NameeZ-V- -T lsC� ztJC,, ❑ Corp.I X .—xln'i
-1
Address � 0 �(Lart-SL -U¢JLC 33(�
1 1 � � ' � Partner.
BusinessTeleptione q -yam _G` I �SU0 Firm/Co.
Name of Licensed Plumber: V\AA-t`kN--'
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy �I Other type of indemnity ❑ Bond ❑
Insurance Waiver: 1, the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance I
Signature Owner Agent ❑
I hereby certify that all of the d�tails and information I have submitted
(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent previsions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By: j "L.� `�Ll---
igna ure o1 I-icensea 1,1115,371
Title r Type of Plumbing License
City/Town
icense lNumoer Master JourneymanI. ❑
APPROVED(OFFICE USE ONLY
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Date.. f`�.: ."�.�.......
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NORTH
jpy`„•o ho
3 TOWN OF RTH ANDOVER
i o PER OR GAS INSTALLATION
y
'1sySSAC NUSE��
u* This certifies that .. . . . .
/�
has permission for gas installation . ,_..h�. . . ,. . /-,/ . . . . . . . . . . .
in the buildings lof . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . .
at . 6 �-��- -: . . . .` , North Andover, Mass.
.r Fee. . . Lic. No.!�� -��. . . . . . . . .
' 4 GAS INSPECT R
Check#
i
5351
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T
I �
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I
MASSACHUSET'T'S UNIFORM APMCATON FOR PMU TO DO GAS ffnING
(Type or print) I Date
NORTH ANDOVER,MASSACHUSETTS
Building Locations �a � �'�` — Permit#
Amount$
Owner's Name \9 S
New® Renovati In ❑ Replacement ❑ Plans Submitted ❑
I
>0.
�;
d 0 w cU� '"
10 1
10 1
SUB -BASEMENT
BASEMENT
1ST. FLOOR I 1 �-
2ND . FLOOR 1
3RD . FLOOR 1
4TH . F L O O R
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type) ChgQk one: Certificate Installing Company
Name ^1"E, Li 1 is G11- `L Corp.
Address ❑ Partner.
usmess Telephone Ct-Z$ 777-17-77777 Firm/Co.
I
Name of Licensed Plumber or Gas Fitter \C-t— '(\AvcA 1\-k .
I
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑
If you have checked yes,)please indicate the type coverage by checking the appropriate box. 13Liability insurance polio+ ® Other type of indemnity [3Bond
Owner's Insurance Wai I er: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass.General Laws,ani that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
Signature of Licensed Plumber Or Gas Fitter
By: I Plumber f
Title
City/Town I ❑ Gas Fitter License Number
Master
Journeyman
PROVED(orae)USE ONLY)
I
I
cDate.........:`.... ...............
NORTq
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
Y
,SSACHUs�i
......::Q:::'::.............................................
This certifies that ..........._..............�:�'�::¢:-t—�
"rlas permission to perform, ... �'r/
4
.fit-!�r�:::`:f!a..l... .......................................
C ,
�iring in the-building of...
at...a......_................................. ........................,North Andover,Mass.
.-�
Fee............' . Lic.No.11.��. .,�#4. .j..... � _ .......
/ L'CECTRICAL INSPEG�"S'OR
Check #
5785
1HBLUMLYluiv{EYP-4 L111IUrLVJHi)JLiIClUJL'11J vAAI�uuacul
DEP OFP �UXJCSAFE7Y Permit No. 5—
BOAROOFF7REP ONREGUTARONS527CMRI2:00 ,�7�
Occupancy&Fees&SeflU=
APPUCAHONFOR,,I' TO PERFORMELECTTIICAL WORK
_ ALL WORK TO BE PERFORMED IN A XOR ANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
` (PLEASE PRINT IN INK OR TYPE ALL INFOR ATION). Date
Town of North Andover To the Inspector c
The undersigned applies for a permit to perforn
/he electrical work described below /
Location(Street&Number) aloes S--• L 67l
Owner or Tenant
owner's r' Address
Is this permit in conjunction with a building permit- Yep No (Check Appropriate Box) -V 6 Y�f Z
Purpose of Building ��� (t Utilit}YAut onza ion�To
Existing Service Amp �VOits Oveibead'm Underground No.of Meters
New Service —_ Amps / Volts Overhead MUnderground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work77
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Tc
KI
No.of Lighting Fixtures Swimming Pool Above Below Generators K\
ground ground
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones,
Tons
No.of Disposals No.of Heat Total Total No.of Detection and
Pum s Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local Municipal ® Other
Connections
No.of Water Heaters KW No.of No.of
Signs Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
OTHER-
htstaatoeCor�ap�Rustrmtbtheiegt�arlaltsofN�GeneralLaws
IbaveaamettLiab&ykmamPo yarilffgConlplele Carwdgearisstib te4nva>at YFS NO
IhavesuWi&dvandpo0f0fSM1elDdVOB'ice.YESF oulimeched®dYl;'S,Ple�einr& thet)Peofmvaarby
cheddTlbe
MURANCE BOND GIHQt (P"WSF*)
EstM"Valreofl WC1k$
WorkbShnt IrtspectivalDateReWe*d RteS'-23'Q Flnal
L SignedunderTiePl dperjuy. w�Q U _!C ,cam(/ L ��+
FIRMNAME /
14
=icensee /- W�"Q r✓l(� SignatureLicenseNo
m
J y+ / (�
Tel No.
Z f Lt,H�SK reWdtess /&4f4 I Alt Tel No.
OWNER'S INSURANCE WAIVER;I am aware that theLice se does not have the instrar>ce comrage orits st>bstanial mpivalu t as requmed by Ma%actatsetts General Laws
rO that my signature on this permit application waives this recuirerrult
Please check one) Owner Agent cry
Telephone No. PERMIT FEE
Signature o wner or gen
L)PQHlKLMP—NIVPFUffLJC, P,IY Permit No. 55-19�
f BOARD OFFIREPREVEMONREGUL47YONS5rCM?12:1X1 t� ,
Occupancy&Fees C�L•slteti
APPLICA71ON FORPER&HT TO PERFORM ELECTRICAL WORK
+ ALL WORK TO BE PERFORMED INA CORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
1 /heTown of North Andover To the InspectorThe undersigned applies for a permit to perfo electrical/work described bellow.
Location (Street&Number) 1�/{�.41it `T`• C3 T !( g "'
Owner or Tenant j-' . � Q
Owner's Address (A
Is this permit in conjunction with a building permii.0 Ye,5= No (Check Appropriate Box)
Purpose of Building 16t =0nU�
To
Existing Service Amps ! Vols Overhead Underground No. of Meters
New Service �T4
0 Amps / Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work �� �'� —7777
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Tc
KA
No.of Lighting Fixtures Swimming Pool Above Below Generators KA
ground Rround
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones,
Tons
No.of Disposals No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
} Detection/Sounding Devices
No.of Dryers Heating Devices KW Local Municipal Other
Connections
No.of Water Heaters KW No.of No.of
Signs Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
OTHER.
TrmuarreCova�PtlrstlaYbtheiec}�tar�erisofNL�a�sC�-alLaws
IhaveaamerttLmbt3tykardncelbicysrixfulgComplele CoveWortssubswWegtivaht YES/ n NO
1. IhawsubniWdvafidpo4c(swr1DlheOffice.YES If)mtnwdndodYES,pleageirxicaiettr peofamrag,-by
INSURANe� BOND UIIILR � (Plf�seSP�Y>
u Fnve
E— E&1r&dVaJtrdBMk1ca1WCdL$
WtxkbSlartp f)W
Siglod=11rTr ofperjtry.
FIRM NAME GF r.Ji't? c.Q ;7
zc!rAt,^P Signalum!
(.
s � / BusirtessTel No. /7;�<;��5� 771s�—Y� lI/�,f,f -
At Tel Na
OWNER'S WSURANCE WAIVER;I am aware that theLicer>se does not have the iristuance coverage orits subZnW naval as mgmed by Mssactntsez G neral Laws
nd That my signa4 ue on this permit application waives this tegtlitemft.
Please check one) Owner Agent _ ti
Telephone No. PERMIT FEE$1,-D�]
tgna ure ot Uwner or. gen
7 + ,
G THE COADIONWEALTHOFA ASSACHUSETTS Office Use o.
DEPARTNIEW0FPUBUCS4FETY Permit No_
BOARD OFFIREPREVEMONREGUL47YONS527CMR12.,00 ,.tt,,
Occupancy&Fees`Ch ckeJd
APPUCATIONFOR MART TO PERFORMELECTMCAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector c
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) � Salo W S^
Owner or Tenant ID P' — S— [,t 6
Owner's Address r,14 CA S 77 ` MA
15 ` et
Is this permit in conjunction with a build' permit: Yes No P (Check Appropriate Box}
/ `fS
Purpose of Building jt C /�
Utility-Aut i onza Yron o
Existing Service Amps ! Volts Overhead Underground Q No. of Meters
New Service /A Amps / Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work 0
No.of Lighting Outlets No.of Hot Tubs No.of Transformers To
KI
No.of Lighting Fixtures Swimming Pool Above Below Generators KI
ground ound
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones,
Tons
No.of Disposals No.of Heat Total Total No.of Detection and .
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices-
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local Municipal ® Other
No.of Water Heaters KW No:of No.of Connections
Signs Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
OTHER•
L�CoMWW PmmttithezegmmrntsofMasaduscUSG=2alLaws
IhaveaQmutlialxlitylrmanoeRihymhxhrgCorr COvesagecrAs sttsmaW eWabt YESAE:J 1V0
IhavesubrnWdvandpro0f0fsametotr0ffioe,YES If)ouhaNedrdCCdYES,pleaseinc3c ethetypeofw�rageby
cheddngthe appto boy L-1
INSfJRANCE BONDM OTHER
1 d VahrofEbchical Wak$
WaiklDSL?A S'' "—O S^ t
SFIRMNAME 1 ofperltny. �wrf.1 c-k VR-C-6--1-C.�(" .
LicenseNo.
:jcensee C:�tC y'S �aw,.��� Signa LicermeNo
�' - r - BtlmtessTelNo. 2s �` �
Alt Tel No. _
[�) OWNER'SINSURANCEWANEf2;Iamaware thattheLicer>sedoes nothavetheiriA,uar>cecoverageoiits st>tstantialetptivalentastegtm:rdbyMassact>l>sellsGetiedvt51a
andthatmysignahueonthispcmtapphcahonwaivesthi mgmmfnt
Please check one) Owner O Agent ® �,
Telephone No. PERMIT FEE s
rgnature of Uwner or Agent
shi
- :.,
�k
m. r
The Commonwealth of Massachusetts
Department of Industrial Accidents
d Office of Investigations
Boston, Mass. 62111
Workers'Compensation Insurance Afildavit
Name Please Print
Name:
Location: ��� Z 3 — d >� �✓^
City Phone #
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
City: Phone#:
Insurance.Co. Policv#
Compgriy 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$1,5o(
and/or one years'imprisonment_as._well_as_civil.penattiesinShelx m-&A_STOP:Vti/_ORK ORDFR.and_a.fine_of..($1DOM)-aAay.against.m e. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DtA for coverage verification.
/do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature Date
Print name Pbone.#
Official use only do not write in this area to be completed by city or town official',
City or Town Permit/Licensing
D �
Building Dept
FICheck if immediate response is required llcensin4 Boai
p Selectman's O
Contact person: -Phone* Health Departs
Ei Other
•
rDate..................................
• NORT"
°f,•``°:• '"° TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
- � 3
SSACMuSEt
c�
Thiscertifies that .....,. ................................................... ................................
n
has permission to perform . ...................................................
wiring in the building of. S / - 4� .......................................
at....p s >. : *. �. .._ .......................... ..NNo�rth Andover,Mass.
Fee. `e............ Lic.Ni ............. .. �... TR ,g
�J iLECICq[.INSPECCOR
Check # �Ja1� (/ !1✓/ {
official Use Only
Permit No. (� 5
057ISs.4em.S577S
V*04.4w 4 Pa.54%�' Occupancy&Fee checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
NI work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
/i _yy_c �
(Please Print in ink or type all information) Date To the Inspector of Wires:
Town of North electrical work described below.
Andover
The undersigned applies for a permit to perform the electr�� ,�_
Location(Street&Number �Z a- - `1
Owner or Tenant /P / (,I Nt(G
✓V11 RIC—
Owner sAddress i 1
Is this permit in conjunction with a budding hermit Yes No ❑ (Check Appropriate Box)
=_
,�2q g /0
Purpose of Building f i ✓\( �s� A/`1 Q `"' _ ljiitity PuaThorva#ion Na
seavice .� Amps volts Overhead ❑ Undgmd ❑ No.of Meters
New Service 2-C�Z� I Z6 J 2,Yd Vdts Ovedvad ElUndgrndd,�1 Na of Meters
Number of Feeders and A iVacty ^ o
Location and Nature of Proposed Electrical Work
ti
Total
�No.of lighting Outlets No.of Hot fuse No.of Transformers KVA
Above ❑ in ❑
No.of lighting Factures Swimming Pod grad ❑ � ❑ Generators KVA
No.of Emergency Lighting
No.of Receptacles Outlets No.of Oil Ou BatteryUnits
No.ofSv✓itctm Outlets No at Gas Burners FIRE ALARMS No.of Zone
Total No.of Detection and
Na of Ran No of Aar Cvnd: Toms Devices
Heat Total:, :.TOW;
No.of Diposal UM pumpsTons KW No.of sourdimg Devices
Nol of Self C_ontained
No. Dishwashers Area Heating KW Q Municipal ❑ Other
of Dryers Healing Devices KW L)cEd C.onnecbon
No_of No.of L.ow Vdtage
No.of Water Heaters KW Siam Bamlases W
aft
.No.Hydro Tuds No.off k-- Total HP --
OTHER:
INSURANCE COVERAGE. Pursuant to the requi of RAassaehusetts General taws
1 have a bility lnsuranF a Policy incl ted Operations Coverage or its substantial equi YES NO =
submi proof of same to the YES= = tiyau have checked YES please indicate by checking the appropriate box
INSURANCE = ND = OTHER = (Expiration Date)
Estimated Value of Electrical Work$ (, /((C
Work to Start �/� d a Inspection Date Resquetesd Rough
Signed under the Penalties of perjury: �a C> C n
FIRS&NAME 1 M.NO.��
L
L��C -�j„f,�f- C. vfl"2.N(gSignature % NO.
Bus.Tel No._
Address L`iZ/tea f+2`Cl a l^@ /cam fGt r 4 Alt TeL No.
OWNER'S INSURANCE WAIVER: t am aware that the Licenses does not have the insurance coverage or Its substantial equivalent as required by Massachusetts
General Laws.And that my signature on this permit application waives this requtrement. Owner Agent (Please Check one)
X719.
Telephone No PERMITTEE $-'
(Signature of Owner or Agent)
�y G
w
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T
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6068
Date..................................
NORTq
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
�,SSACMUSE�
yam,
Thiscertifies that .,... .............................................................
'. gas permission to perform ...t..-. .G.. .... k ��!t........................................
p wiring in the building of
.:
.. ..
U ... ......................... .... .......................
V
at. ..... :...................North Andover,Mass.
aid
Fee..'�(.4..." Lic.No?. (l........ �R/--'
ELECTRICAL
Check # L� ��
8A411DOFF=PREVFNI WRB=A711011 M7Gff12 t+andeNa
Otmupsncy R Fen Otecked
APPUCA71ONFOR PERMTf TO PERFORM CTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PR INT IN INK OR TYPE ALL INFORMATION) DgtE
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) 6 :2 a soy�,c wl S-14.
Owner or Tenant �0-7 > /OLe?a
Owner's Address
Is this permit in conjunction with a building perdrit: Yea® No a (Check Appropriate Box)
Purpose of Building S /We h f/a � Utility Authorization No.
Existing Service Amps I Volts Overhesd Underground No.of Meters _
New Service Amps...1 V oltsOverlied Underground Q No.of Meters
Number of Feeders and Ampacity
Location and Nam of Proposed Electrical Work
No.or Lioft Outlet Na of Hat Tube Na orTnn/onnn Total
KVA
Na of Lighting Rstotes Swbmh*Pod" Above Below 0merabora KVA
younil El
Na of Receptuele 0011012 No.of 06 Bernet Na of Frnergency LigWng Baaery Units
No.of Switcb Outlet .
No.of 00 Barnate
No.of RwWs No.of Air Coad. Told FM ALARMS No.of Zoom
Tone
tC d Disposal. Na of Had Told Totd Na of Demcdo n Dad
polove Toa KW Initledng Devices
No.of Dishwubet Space Area Hoeft KW Na of
Na of Self ContsbW
DetNo.d Hesthq Dsvkes KW ocase11oal9oa rdrrg Davlesa
Local �.moteCotton Other
No.d Wager Heater KW Na d Na d
shm Bailnis
No.Hydro Mauge Tda Na of Motor Told HP
!'YT4rRlt• /� C/Y al /tet'�' /7�Gj �'/'�
ttatttataeCb�m�:Ptraa�bbere�}>ierrlmrad'MsedlserCimmll�tts
IheactuNLitx ) tPcftizkftbnqU arib&*dw e4iAW Y® NO
IreT)uubwchedeygPk=kdWhi�pd
,r fle bm.
>rsuRANlzEl BCM D on= 0
�ae
WadcbStaR ,1S 0 i;=D&Rafa�d Rtxgb
Find
55gtledunder Pene�afpajiL r. v �v /��f t O�/��/N
fRtMNANIB 1icambla 'T
�o 71�
&W=TdNa j7gF-6 9.2- G Y7 Y
�/
ALTUNd
OWI�MSIIGURANMWANPR;IomaamintleLimwdmmthmdleissaloeaxwrcrbarh,arlidagiivdunngimdbY aff=WL n
mdtltetrrwsigritancriftpmrli.picaita�liragaiersnt
(Please cbeck one) Owner Agan
WIN=or OWN or p4log Telephone No. FEE S sec
e
t ►
*a #
�SSACHUS
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 426 (12/17/2004 Date: July 31, 2007
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 622 Salem Street
MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH
OTHER REGULATIONS AS MAY APPLE'.
Certificate Issued to: P. J. S Realty
87 Church Street
Merrimac MA 01860
Building In pector
NORTH
own of 4Andover
® S3 A dower, Mass., /02 —�#7"a O O S/
I� COCHICHEWICK ��
7�S RA7ED PPS\ �C:)
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
�� / y BUILDING INSPECTOR
THIS CERTIFIES THATT�4.� � Vb�
Foundatio t'i�-�- S :�a
has permission to erect.............. ..... buWings on.. �!Z o� S a /!/!1 Ro
�..
........ .. ..................................... ..........
to be occupied as.:.� RoO l�f� a 11 ITh, S �l/ v��le� SrrufS/ ey
............................................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in inal
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. ` S
PUbMBING INSPECTOR
01
VIOLATION of the Zoning or Building Regulations Voids this Permit. ug `rl> o s-
PERTT.ME)TMES IN 6 MONTHS ina 3`��7
UNLESS CONSTRUCTI 4S S ELECTRICAL INSPECTOR
rvic f` P L I j,
LDING INSPECTOR nn
�dv/e 7- 2y-a7 /'/117
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
- No Lathing or Dry Wall To Be Done 7 :? LnI2_
Until Inspected and Approved by the Building Inspector. Burner
LL
FIRE DEPARTMENT
Street No. 2/
-�f
SEE REVERSE SIDE Smoke Det.
� ' T
rVk0RT►j .(� 7
- - — -
4 e
sS 5�
' COW APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
Buildinst Permit# 2,C
ADDRESS/LOCATION OF PROPERTY : S7
Map Parcel ( Lot Number j, Z
SUBDIVISION
DATE REQUESTED FILED/READY FOR INSPECTION
CLOSING DATE ON PROPERTY:
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-
INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE
DOES NOT MEET ALL APPLICABLE CODES.
Permit Issued to:
Address
SIGNED
ROUTING
CONSERVATION
GO — Nct�ippba.y(�.
PLANNING ® frJ i,,&l c,IA'1--eAs
DPW-WATER METER LZ4/dx(o
SEWERIWATER CONNECTION EZ
NOTE
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST
DPW t oi►_ I` n�� la3,1O-Oy"I
Signature
File: Application for OC form revised Jan 2007
�10RT11 _
4 ►
bb
� ^fit ws '►
,ss�`"VSEL APPLICATION FOR CERTIFICATE OF OCCUPANCYNNSPECTION
Buildina Permit#
ADDRESS/LOCATION OF PROPERTY : (,,jj 5(-Je , 5 i
Map Parcel If Lot Number j, z
SUBDIVISION
DATE REQUESTED FILED/READY FOR. INSPECTION
CLOSING DATE ON PROPERTY:
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-
INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE
DOES NOT MEET ALL APPLICABLE CODES.
Permit Issued to:
Address
SIGNED
ROUTIN
CONSERVATION
LQ - Nct ��af«.ti
PLANNING
lUo �_ ce1A ° Srj rl �lir�
DPW-WATER METER �4/aX(0
SEWER/WATER CONNECTION
NOTE
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST
I
DPW Q 1K. 1+' it 0 n r 1 /� �-311 U"F b- '-1
Signature
Fife: Application for OC form revised Jan 2007