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Home My WebLink AboutMiscellaneous - 626 FOREST STREET 4/30/2018 626 FOREST STREET 210/105.D-0023-0000.0 .� r , i I 1� ,, ® MAPFRE The Commerce Insurance Companyw Citation Insurance Company'' Commerce " Gore Road,Webster,Massachusetts 01570 INSURANCE" 508.949.15001 www.commerceinsurance.com April 282015 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall N ANDOVER MA 01845 RE: Our Insured: SCOTT SIMPSON/KIMBERLY A SIMPSON Property Address: 626 FOREST ST Policy#: BDDTXD Date of Loss: 02/12/2015 File#: JWWC34-HNPRVO Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. VALERIE SABO Telephone: (508)949-1500 Ext: 15076 Claim Specialist,Property Toll Free: 1-800-221-1605, Ext: 15076 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above,by first class mail. April 28,2015 _ . ._ t , f f CIC 254 (Rev.4/95) MAIL, 786 77 u a Date. .. . ... .. N°RTI, °f ,°,9,° o? TOWN OF NORTH ANDOVER F 9 • PERMIT FOR GAS INSTALLATION This certifies that . .`:`.k vii . . . . . . . . . . . . . . . . . J has permission for gas installation {'F -� in the buildings of . . . . . . . . . . . . . . . . . . . . at . . . � 00.K.6 T . . . . . . . . . . North Andover, Mass. UL.Fee 3U•5P . Lic. No.J.P l04.4, . . .s GAS INSPECTOR Check# .2 0 33 601 Sj5-cU MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:_N0 (,/d (tiPV- —' MA. Date: /� Permit# *OVBuilding Location: a(p � S t Owners Name: CGt ul1en Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: RT Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES Cd W ~ Z W Q W W 0 Ca X Z F- O LU Z J >- W Z u) 0 W W 0 FW- W O Q H v5 w co w g m O O WX W m V w 0) m 0 ~ w N 0 Q a. w = a: Lu Z W W Z 0 J i— F 0 Z -j V' W H 2 w H W W U 0 a u=.. ((D 0 2 .ZW. O a. H > > > O SUB BSMT. BASEMENT 1 FLOOR 2 Nu FLOOR C fu--FLOOR 4 FLOOR < 61H FLOOR 6 TH FLOOR 7 FLOOR 8 FLOOR �1 - EE R- Che One Only Certificate# Installing Company Name: /j�}-�f'✓I�/'S ,P/S / / Corporation Address; .��Q/rlgti�ryc,/U4. City/Town: .4a>!C°/J _ State: ❑Partnership Business Tel: -271 Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter:� *j us. f INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please indic the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity Y ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner 1:1 Agent E] By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: ❑Plumber Title ❑Gas Fitter Signature of Licensed Plumber/Gas Fitter ❑Master City1rown ❑Journeyman License Number: C�+.0 01o,4 APPROVED OFFICE USE ONLY El LP Installer 0 2 7 Date�. '. 1........... µ0RT" TOWN OF NORTH ANDOVER ° PERMIT FOR WIRING ,SSACMUS� - This certifies that . L �n>G ��G�' <..�'...................... has permission to perform �i! t!i '- 'd... T'''..... wiring in the building of... a.zi ......az`e ��?.......................... at.....45 ......� ?� ��.................. .North Andover, ass. Fee.7.�?...!... Lic.No, .l �.... ..... .. ......... .ICA ........ .... ELECTRICAL INSPECTOR j^ Check N Commonwealth ®f Massachusetts Official Use Only t Department of Fire Services Permit No. /G / Z BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELE ap All work to be performed in accordance with the Massachusetts Electrical Code(MEC)527 CMR 12.00 Y�®R� (PLEASE PRINT.ININK OR TYPE ALL WORMAT10 City or Town oh NORTH ANDOVER � Date: By this application the undersigned gives notice of his or her intention to perform the els electrical weqtor ordles nb Location(Street&Number) �0 2,(* ed below. S Owner or Tenant S` Owner's Address Telephone No. Is this permit in conjunction with a building permit? Purpose of Building Yes NO (Check Appropriate Box) t Existing Service Utility Authorization No. `APs _Volts Overhead ❑ d Und Lew Service g ❑ No.of Meters Amps ❑ Number of Feeders and.Ampacity _ _______Volts Overhead Und grd ❑ No.of Meters Location and Nature of Proposed sed Ele ' P Electrical Work: Vii' Com letion of the followin table maybe waived by the Ins tor of Wires. No.of Recessed Luminaires No.of Ceil-Sus No.of tom•(Paddle)Fans Tota! No.of Luminaire OutletsNTransformers KVA o.of Hof.Tubs Generators K:VA No.of Luminaires S Above ❑ �- v+im�ming Pool Bait mergency lg g - No.of Receptacle Outlets d. nd. Batts Units No.of Oil Burners F]1P A1r _RMS No:o f zones No.of Switches No.of Gas Burners No.-of Detection and No.of Ranges Total InitiatingDevices . No.of Air Cond. No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons ns Totals: ""'-'-'�""'-" -••-•---_. ' No.of Self.-Contained No.of Dishwashers Detection/Alertin Devices Space/Area Heating Local❑ Municipal No.of Dryers Heating Appliances A liances ' Connection ❑ Other No.of Water KW Security Systems:* Heaters KW No.°f No.of Devices or E uivalent Si Ballasts No.of Data Wiring: s _ . No.Hydromassage Bathtubs No.of Devices or E uivalent No.of Motors Total HP Telecommunications Wiring; OTHER: No.of Devices or E uivalent Estimated Value of Electrical Work: Attach additional detail if desi �'o`� red,or as required by the Inspector of Wires. Work to Start $, - m (When required by municipal policy.) _(4— Inspections to be requested in accordance with MEC Rule 10,and upon INSURANCE COVERAGE; UnIess waived by the ownercompletion. unless the lieensee.provides proof of liability insurance inc ,no permit for the performance of electrical work may issue luding"completed operatiocoverage or its substantial equivalent The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. ss n" CHECK ONE: INSURANCE ❑k BOND ❑ OTHER I certify, under the pains andpenalties o ❑ .(SPecify:) P fperjury,that the information on this application is true and complete. FIRM NAME: ( ��( S .� trVIGV �- Licensee: (_.o LIC.NO.: 416 9 15 (If applicable,�en r"exempt' in the lits e nuer line. Signature LIC.NO.. lS Address: 9 2 9 "-r Bus.Tel.No.: (ao 3-L3S- qct;" *Per M.G.L c. 147,s.57-61,security work requires D ';� of p N 03e�� OWNER'S INSURANCE WAIVER: I am aware that Licensee doesSafety"S'�License: �n Licl No.��s "952-� required by law. B m signature not have the liability insurance coverage normally Y Y gnature below,I hereby waive this requirement I am the(check one)❑owner Owner/Agent El owner's agent. Signature Telephone No. PERMIT ELECTRICAL PERMIT NO.. INSPECTION REP®RT: ELECTRICAL INS-PECTOR-DOIUG SMALL .? =] Failed : Failed—[ ] 00)-[ j Signature-no initials) s Date Z.FINAL INSPE TION; Passed—[ Failed—[ ] Re-inspection required .00)_1 ] Inspectors'comments: (Inspectors'Signature-no initials) Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ J Re-inspection required($50.00)-[ ] 4 Inspectors'comments: (Inspectors'Signature-no initials) Date 4 , 4.INSPECTION—SERVICE: - DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ J Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date k 5.INSPECTION-OTHER: Passed—[ ] Failed—[ J Re-inspection required($50.00)-[ j Inspectors' comments: (Inspectors Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ONSITE IF THE AREA TO BE INSPECTED IS N07[` ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. s. The Commonwealth of Massachusetts Department of Industrial Accidents Office of LnVesfigations 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I.e 'bl Dame(Business/organization/Individual): c�-Qrv��y Address: �t -- City/State/Zip: tJPhone#: 6 _ � 3 q52- 4S 61. F22. re you an employer?Check the appropriate box: am a employer with 4, Ty;E1 of project(required):❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 New construction❑ I am a sole proprietor or partner- listed on the attached sheet. I F• Remodeling ship and have no employees These sub=contractors have 8. working for me in any capacity. workers' comp.insurance. . [:]Demolition [No workers' comp. insurance 5. El We are a corporation and its 9' E]Building addition 3.❑ required.] officers have exercised their 10.®Electrical repairs or additions 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 ive have no insurance required.] t employees. [Ado silorkers' 12.❑Roof repairs comp.insurance required.] 13.❑ Other " Y a'rr ant ghat checks box Yl mst also fill cut tae sectio..be.o.. woncinformation.policy s ,.,sho:w W. r t Homeowners who submit this affidavit indicating they are doing all work and then jure out ide 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'omp.policy information. am an employer that is providing workers'compensation informatiom insurance for my employees Below is the policy and job site Insurance Company Name: IX(Jr_ GY tiw Policy#or Self-ins.Lic.#: w G e Expiration Date: 3 11 Job Site Address: (P2 City/State/Zip: M 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c fy under the pains and penalties of perjury that the information provided above is true and correct Si atur e: Date.: Phone#: -L 3 3- 1 f Official use only. Do not write in this area,to be completed leted b P y city or town offcciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.PIumbing Inspector 6. Other Contact Person: Phone#• - _- UMM - . NWEALTH OF MASSACHUSETTS MIMI= 112 IN ELECTRICIANS REGISTEF ED.-MASTER ELECTRICIAN ISSUE THE A-D V_E LIQENSE TO ".: ALPIN.EIELECTRICAL SERVICE._ IN R:-ICH.A`RD 'F DEL'VECCHIO. Y 7DEER.-FIELD ST SALEM:- NH 03079 137 _C.OMMtONWEALTH OF MASSACHUSETTS w ELECTRICIANS ASA UP1�UNEYVVIAN ELECTRICIAN ..' I S< EA VEP. .-tI NSE TO,.-.-7-.1 • „` . ... R`ICHA:R.DF DEL 1/ECCHIO..-- T DEER-PIE.LD ST ` SALEM _NH 0307;91/13 • 771 .- _ • Location No. Date ,A0* #I TOWN OF NORTH ANDOVER h 9 " Certificate of Occupancy $ ;'sscN Eta Building/Frame Permit Fee $ // D , r .. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ / Check # 138 C �, O ` Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: >��-- - i SIGNATURE: Building Commissioner/I for of BuildingsDate SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: D 3 ( c 41 ��^ `r �-s4 Map Number Parcel Number r 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft v 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Reqtdred Provide R 'red Provided ReqWred Provided 1.7 water Supply M.G I..C.40. 54) 1.5. Flood Zow Information 1.s Sewerage Disposal System: Public ❑ Private 0 Zona Outside Flood Zone 0 Municipal 0 On Site Dispcisal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 wner of Record � _o r�� os z S E l � �s � 6 � � o Nam Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. ` Not Applicable ❑ Licensed Construc*ion Supervisor: iµ License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 4 i ji SECTION 4-WORKERS COMPENSATION(nG.L. C 152 § 25c(6) i 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.......0 SECTION 5 Description of Proposed Work check all applicable) i New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: o 5 a &,C-f SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be2111 Completed by permit applicant Y 1. Building (a) Building Permit Fee �j Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee(a)x (e) 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7aOWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Si ature of Owner Date SECTION 7b OWNER/AUTHORIZ D AGENT DECLARATION I, S ,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 0 ✓I Print me 0Sign,&wwe of Owner/A ent Date F STORIES SIZE' BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DINIENSIONS OF SILLS DIMENSIONS OF POSTS DIlVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM �V-kK® ee. 1 M UA INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION****************** APPLICANT )L, PHONE LOCATION: Assessor's Map Number Ids D PARCEL SUBDIVISION LOT(S) STREET / v2y ' r '�� S S ST. NUMBER �� *****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED \/ DATE REJECTED S TIC INSPECTOR-HEALTH DATE APPROVED ()Z DATE REJECTED COMMENTSN �� -, t; fie,� � ��S �� T, e J;-- 6�G PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 im 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: Location of Facility) r Signature of Permit Applicant 112-lol Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector + NORTH Town of North Andover ? , '+ Building Department 27 Charles-Street � a North Andover, MA. 01845s�+n D. Robert Nicetta Building Commissioner (978) 688-9545 ":(978)978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print/ DATE ! Z02- JOB LOCATION 62 Number Street Address Map/lot "HOMEOWNER/0S �pf eGS —P 3,3 l 7�1 eq�kP Home P ne ame Worhone PRESENT MAILING ADDRESS City Town State Zip Code i The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEINOWNER: " Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- I cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. • I The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, bylaws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE 1 APPROVAL OF BUILDING OFFICIAL ' 1 F S I 1 , I Y � I I I I I i i I , I I i 1 + I I I1. _ .---I•--•- - I -�-----�--- - ' 1 I I I I r i � I I I � 1 I I � ' I I r (/ + 1 I � t 1 4- I I I I I I I i { I r I I ' i I i I I 1 1 � J '� � i I i __�.�� 1 i ._ -- .• I �- I � I j I , tfi , 1 ,... I I i I� � 1 � I _ ..� - �.I _- - - - -I Imo_ ._� �' �_ _� �� 1 ! - -. ;.'y- � - - i I • J _ ,f.moi__ -�- __ - - -_--_ I--�_ i �, � � I � � I s � 1 � _ . - + —r— — � —— . — — —. — .. — ——•—� — — h� 1 !-� 1 i � I ....� �..s•. _ i � 1 � II I � � � t 1 - - - ��' - - _. _- _ -. - � --� � - - -- - j -- - -. - - � , a _ { i I{ 1 I' I I ] i � IT � I I I i I i _ � �.._ _ _ � 1 �___ I -_ �-_ _ _ -._. ' _ _._�_ - -'- ' y- � � � .I.� _.5_ ' -- - � - - .—!ter - .. .� _.� �`—*.��-: - -- �- '• � � , ,� 1 I _ .. � �`-- 1-- j -r i � I i , 1 I � 1 �' � 1 I 1 � � 1 � , i t f � — �--:-- -{ � � 1 � -- ' 1 '_ I I i 1 � � I I i I I 1. �'�' 1 � i 1 1 i 1 � � i. i � i , I � � I i � 1 i � , 1 �� i i � 1 1 � I t i i _ �-_ �i----� - .- � _..•.� .r �---_- I � I I i _ _.._ . i � I rII '• i i � 1 _ f ry - �.-_ - - - .� ...-- - - - _ _ .� ' - -�- I 1 I i 1 1 , v I I _ _ _ _ _ _ _ _ .. _.L _ ._ _. _ _. i 1 ' ef 1 9 A- t + i r i }• , , � 1 � � a � � + i .. � � fir. . 1 I II I I� I I I I. � •' • ++ I I I I I ff�• i ._ I.L. _ .—_ .. _ � .. i —_I_—.�_ •�_.Ev—T _ _ _� —�—_� T— �—J. i ..�— .i._ _ i _._ � _ _• _ � —_ I I I I I — ._.--I 1 I I -+'-- {. �. I '—';"` i. i + 'j —1I I 1 I I I I I � i 1 •I-~a i I 1 I rot FT, I I 4 -t ' I , i I I i , + + + + I ;. -• - -. - - - IIT i t + i ' I I 1 ' ' i I I j I I � • T t r t + } { 4 + + r + + y. } 4 1 t + .. y. 4 r } 1 I. i. .}. x 1 ' I � I . I 1. I ,�. � � i.- !- -. - 'i' f f ! _* - - - -•�. _ .�. � I i � - y .r. I_ _ .. _ 1 �- ' 1 I t -I TI" --------- -- — — I — - I I � t I I I n -, -- � - f �# � t.-. •I. _I ! I I I ., � ! �� I I.. _ -_ �- I __ _I `VT 1 1 ! I , I � � I 1 I •I I I I 1 { , Official Use Only Permit No. � ?�cs'(,dn�Zd72ZU�rf1�7�f d3 SS�(�ZtS�7'7S Vow—t 4;06A�,_•S44 Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK jAll work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover I The undersigned applies for a permit to perform the electrical work described below. ,[ i Location(Street&Number Owner or Tenant / t� / Owner's Address Ui 4 r Q re Is this permit in conjunction with a building permit Yes 6 No ❑ (Check Appropriate Box) o � Purpose of Building 2 e'ery e—L Utility Authorization No. E Existing Service Amps Voits Overhead Undgmd ❑ No.of Meters New Service Amps Volts Overhead Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Total Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di oral No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No..Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof df same to the Office YES= NO = if you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) Estimated Value of Electrical Work$ (Expiration Date) Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC.NO. Licensee signature LIC.NO. Bus.Tel No. Address Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insuranrage or its substantial equivalent as required by Massachusetts General Laws.And t at my signature on this permit application waives this requirement. Owner 4 Agent (!Please Check one) Telephone No�✓ PERMiTEE $ (Sig ture of Owner or Agent) NORTH Town ® :: .:.41Andover V" No. 3Sfi Y - A o lover, Mass., COC HICHEwICK ORATED P'P�:- C3 S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System h /.� 1 BUILDING INSPECTOR THIS CERTIFIES THAT......... ..p. �0.... .......... .. <�. ..,t..tV.aG ......5...................................................................... Foundation ° N/ r... .../................... has permission to erect.........5..�.............. buildings on ..............................�te... QST S .................. Rough to be occupied as.....1't..7T.!�....�P!�.C!.:....�..... .../"145'f'�/e... I'!I1.......w/..�/¢.�J......... 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. d3 �/�, _ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this rmit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ........ .............. .... ........................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Dec. SEE REVERSE SIDE I! Date. . 4,o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSAtHus� This certifies that : . . . . . . . . . : . . . . ^. . .i.':f'.'.` '. . . . . . . . . . . . . . . . has permission to perform . '. . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . North Andover, Mass. Ji Feel� . . . .Lic. No.: . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # �� S 5216 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING e (T YP or print) ) NORTH ANDOVER,MASSACHUSETTS f� ? �l�f'�� ,r Dae Building Location ./ Permit Owner �j �4�l 7. 9 -'` Amount L,/0 0:!:�©.�>�Q /1 New ® Renovation Replacement Plans Submitted Yes No FIXTURES F O oZ00 :4 z Z a x as a x H x �'' M A N � A a ra SMEM BASEUM MHfM 41H H-" P 5M HAOM r 6MMOOR 7111 RDOR : 91H ,ITJOCR (Print or type) r,��s / Check one: Certificate Installing Company Name /'/�/ c/ !/ t� Corp. Address �C ' �® �y ❑+ Partner. Business Telephone 2- 641 — 35 Firm/Co. Name of Licensed Plumber: �� iL ////�� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: i Liability insurance policy Other type of indemnity ❑ Bond ❑ i Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance �–e4�46; ignature Owner El Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit I sued for this application will be in compliance with all pertinent provisions of the Massachusetts St Priqnrgode W( ter 142 of the General Laws. By: igna ure o icense um er 2 Type ofaPlumbing License Title OO City/Town License lNumDer Master Journeyman APPROVED(OFFICE USE orrt,Y Date.. t NORTI� 4,, TOWN TOWN OF NORTH ANDOVER i .. PERMIT FOR WIRING SACHUS� This certifies that ..L � ............. ..�. has permission to pefform ..(!�!.L% F! wiring in the building of.. .�. 6t..f � ......p................................ ?4 at..(.f. �4& 4 ......................... ,North Andover,Mass. Fee ./i. .... Li ..... 4/_f;.� ... 2SPECT, r'.�/1}� ! y��•�++ ELECTRICAL SR s; Check # 5684 i f �.uludr � d r� /.1T'lr10 /fPumpNof. BOARD Or FIRE fnRFVENTION RE'_r:1 Occupancy Ant Fe•C APPLICATION COR PERM11- I- 11tl �trtflttnitC r , ., t PERFQR� ELECTRICAL WORK(1Crlq,rn.t3 n r oct.l:,,u'c•,, it �IEk"t"' Cnclf (k`1( 1' ()'11'Zt PONT 1,V INK 08 'FY)'11•'..11.L ), t 1. 5),1 CAfR f?00 0ty or ')'(ttvat of: Dyl s ApOic riliott the unt4et:,lu�,u:fJ L I�'C� I11)lit (r+11C ( I+llt`11L`.n +; t �,ti rnl the elcctttral �vnrk cEcst rlbcd Uciou. T ocatiu„ (Street & rVulr,hc; ) Owner or "x nnfrt is this perilfit ill r,ptljultctit) lsll il :t itui Illttu jtrr, : " l fS �� '�,..•.�......,� 1'+„t,us� of a.}uihJiul; L_J I�}tct1: r1i11,,rnilrialo Tfo.Y) �tiSlill] So tit.( �- -- _..._ ( ....._.1' ( 11 C a Ll nd ;r;l ^•-�-.,,,.,..M.'...."`"'"""-_"*-• No. A ,rc rntr5 - - /..T..___1 utic C? ertfcatl ,V L-� ltlacJgrtt o, ofMetert tN'atttllcr of f Pcders 1110 Antisull'V 1.oCaliu,r Ind Nattire_ of Proposr<J unr�irlibu a/,l ally rf,�lurylR xtR M. ._— _ o. 0� ba wwcrf j1�,Ih hf.r efor �f!•('S yn. ttf ftefcsscd FIX ltlres _ -'. - ._.....___�._ +--•...�..__..___....�_..,._.__ '`?n.r,f('ctl.•Susi) if'.ltitl}C) 2'ar15 -....... _ — _._._.�. va. of k.igtrrinti O,Ittcts Nrallsforla,ara }�Vrl —..._._.._.,_....._____.____...._. o. of ltul '}'ul.s ,ellcrafnrf 041 Of A►ttildI �'i.lrlarrs �.1'A _-__.�m.__..._.._..-,_..._._. titii��---�-„........ __.._ B ffe ,Vo. f } Nn,o (till3urn-- �1<lits Rf5 Q f3ecr. ld: E QUltPtS _... -- I1'Ip. of Strilfltes __...,..,., _._ -_.�._ _,., 11'0. Of zo»es _...... 7o of etectiola 11111 i`t'u. of fiances _..-__ ....._.._.__.—�nf�t —”'---_-L,ifi�titt b4lic�s _ '. _ No.of Air Chow, .,_ t,(lvasttr },�;spnsers -- Tons NIX of A1erUn j Det'iea; iJtstJ°t„i++� .ilt;.t+If r 7prls 'SMV___ - _.__..___ y o . cf -ontsTrtcl� _. ._.._....__._.�_______ !lctecfinitl�a ler tl111 �ipacrl,lrrl Dft al ,�, I<11' ,.,�AR,'ices lrtlftlif.ln:11��•^^t�"'"��`�"-"' _I other \'o. of Dlyer.g _......._._..__._.._.._. Cu,t e►i ..-- )Icaf nR ,Apn++:t,Irr`s ccurld 'of�e`'ifcs ar laiyaieftt D ._.__...,_.__.._._.•�_..., ._1 us Jla3tctsls • 11'rring rt Ulantsa. a f ala }tid;hs ddh'sl}end +va. of Mo ctf,4 �cfe-c t1lti T t!' calf s 'tU 13 of of ..._. f•flrR, M ___-._..,_._.._..,__,_.�__._____ -------•_- __._...,�.,�._..11'e?�I�.c,cor�c�i�n�ItAnR ,. COt:E}f.tCE: rArl,rrra•AA+ rGe lns�laGlar of Wires (bililys a•arved bohr nq„tef, n pe:m fpr the PC rfUrmanfe of ctt*rrricaJ work ntay issuc ulttess } the fircnsae flrgvuJl^s proof of ItaUliity Insur.i ,c;^ i,tciuditic 'complcl^c4 pf, ration"covgr�lc o ftt, tmd(:rsfgncd cimtrifs lhaf such covcrlQp- to ft,ri r, d .,S r rl,lh;lcd Trrcf 11 an r gufrsfanti I equivsdlent, 'Talc CI.1f'+';K ONE. \� _ s to to tltc pt^rntit isstrirt }q f1 '5,1,213�1Nt`E f?NE.) r /� +S of,fiee, '5434'.9 r/N M*r1; ✓�A•,t'1/�"'N6A 1C,\�jgff. /'l �_� {).f t II:lt `.� \,�:Cislfr } /' / �+ 1'56111,,fl!t•E V;tit c of E IV(trlca! 1b'nt�.� It ggtby I1:Npualion at) \1�olk to Sl.�,t � iWhen_. __ oj P } _.. Y.:� l,Ispcc1;0"S In hr rt';);,�u r l't'r71 rl, ll:f+�,•,'11,c 1f71lr :InI111n 1 �.,ur1/rr,.'.f nj lrrr j,u1• l;:.,r ; ..;r„ , . d n c urspletion Ff11,1f 1�;1;1ft� lr n;rlhrsnl,1t(ft'Rr,+�r, ntr:r,: _ ICJ,r c l _P._ - f - -_ _ .... — II.JC. ALSO?_ rt \14 f t� -+ ;y,1 11•'(�12• }�. `��...t Tel. H 7 rft�UNc(JU ..!^ +(„ fl n till To 11A.: f p», t ;`•my Sryn_t+ri c br'v, rhy '.I,l it;• Il,+; ;r c I,,,1 l,n:o Ole 1 �!ilia irtSu,,lf+fi fCn erlltf RQrrlfatlV 1l'rf'r5„C111 • i' 1 7111 on S ��1'q r1i 1 Ipil:lltl}'1' t c'1 ��{1 t1I1Cr Ctf'flc 5 1y-^�111. >i U✓ { Date. . . . . . . . NORTH TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSACMUSE� This certifies that,� �. C l.U.!. . �d/. . . . . . . . . . _ 1. . 9 has permission to perform . .1 > . . . . . . . . . . . plum.bin a in the buildings of . . . . . . . . . .fes-'' . . . . . . . . . . . . . . at. . . . - �f��. . . . . . . . . . . . ., North.Andover, Mass. F Fee :dc . .Lic. No.. . . � . j�� PLUMBING INSPEC�R [/� Check # 6404 j ASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING " (Print or Type) ^ � / D/ h ael e ver Mass. Date cx Permit # . 2��y 3. ' Building Location Owner's Name T�72 ems_ nyV ' 7 —LEE~26,f� Type of Occupancy Residential New Cl Renovation ❑ Replacement N Plans Submitted: Yes❑ No ❑ FIXTURES y � Z le Q r♦ r;f V) n n O Z _r O 'U l V Q n 7 C n wn 0 x ¢ Q a W O W a N O a j N a J z o o x x x I- W z a x 3 3 0 x i x a 0. ►- a Y .� w u x Q 14 F' U > ►- O :3r' z a 0 F- = 0 0 0 z z w • 0 t) 'ri 3 Y J Q1 N D p J Q O Q J J Q X CL X 3 m 33 33 � SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 9RD FLOon 4TH FLOOR STH FLOOR 6TH FLOOR TTN FLOOR 8TH FLOOR Installing Company Name Heritage Htg. &Pig. CO. Inc. Check one: Certificate Address 35 Pleasant Street IX Corporation 714 Stoneham, Ma 02180 ❑ Partnership Business Telephone 781 —438-7776 n Firm/Co. Name of Licensed Plumber Gordon Switzer r INSURANCE COVERAGE: -- 1 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liabildy Insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement: Check one: Owner ❑ Agent❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ByQ �x 111'1 t ` �i�e2 o ,r Si ature censedlfi umber Title +. Type of License: Master[$ Journeyman I- City/Town 8 3 2 2 APPROVED O FIE S ONL ) License Number %Z" Watts 9D HI) oil water line to water boiler BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 1g - PLUMBING INSPECTOR .l 3772 Date. TOWN OF NORTH ANDOVER 0 0 PERMIT FOR WIRING 4L "SACHUS This certifies that ........................................................... has permission to perform-%,..-I-I ...........i....... ......... wiring in the building of? —.) .............................................. I - - �11 .. :r;te at... ...... ..................... .North Andover,Mass. r Fee... ..... Lic.No.:......... .................. ELECTRICAL INSPECTOR Check # 111:5111,20 Official Use Only Permit No. �3 Occupancy&Fee Checked_,,�'_--- BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 Please Print in ink or ( type all information) Date.��D To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Owner or Tenant Owner's Address__ 4_ l"D �- Is this permit in conjunction with a building permit Yes'!7 No ❑ (Check Appropriate Box) Q Purpose of Buildina Utility Authorization No. Existing Service Amps �� Voits Overhead L9' Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity p Location and Nature Proposed Electrical Work Total No.of Lighting Outlets No.of Hot No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool gmd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Sailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: t INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = t have submifteo valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of rage by checking the appropriate box INSURANCE P BOND = OTHER = (Please Specify) S�Q�1 _ � Q ©�12-- /J-00 (Expiration D.te) Estimated Value of Electrical Work$ d�'C/ y/�� Work to Start Inspection Date Resquested Rough l,(//"ter Final Signed under the nFtres of pel t FIRM NAME C_' �� . LIC.NO. �! � { Lkensee ��_ 7� Sigri'm LIC.NO. !/J� 6��i,�/ p /�0 J//Bus.Tel No. l0 l7— 2 Address P( /� �f.G6' 77� Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that mysignature on this permit application waives this tegrilrement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ (Signature of Owner or Agent) S-.768 Date..`,7../..l.v.....(J.. NORTH ' °f<<``°;•�"° TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING �7SSACMU This certifies that ..........!"...t....'J... .......... ......T.k!.C..:... has permission to perform wiring in the building of...... ............................................ at.......................................................... .............. .... .North Andover,Mass. Ifee..l..a..:.Uv. Lic.No ............. ......... . .......... .. ....... .......... l. c� ELECTRICAL INSPECTOR Check # ��` ' Oltice Use Only �. � P C�ommolllUPttlt of �tt��ttr u�etttt Permit No. .,� 1epartmrnt of Vublic k"Oafetg Occupancy 3 Fee Checked I BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date MAY 6,2002 City or Town of NORTH ANDOVER To the Inspector of wires: The udersigned applies for a permit to perform the electrical work described below, Location (Street & Number) 626 FOREST STREET Owner or Tenant JOSEPH KULMENTS 978-685-3631 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 ❑ Undgrnd ❑ No. of Meters (flaw Service Amps _� Volts Overhead ❑ Undgrnd ❑ No. of Meters T� Number of Feeders and Ampacity Llocalion and Nature of Proposed Electrical Work WIRE TWO SPLIT SYSTEM A/C. No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. o1 Lighting Fixtures Swimming Pool Above In. grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptaple Outlets No. of Oil Burners I Battery Units No. of Switch outlets No. of Gas Burners FIRE ALARMS No. of Zones No of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.ol Heat Total Total I t Pumps Tons KW No. of Sounding Devices No. of Sell Contained No, of Oishwashefs` Space/Area Heating KW Oeteclion/Sounding Devices i No. of Dryers Heating Devices KW Local ❑ Municipal ❑Other _ Connecton No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wving No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I nave a current Liability Insurance Policy including Completed Operations Coverage or its subslanuai equivalent. YES = NO nave submitted valid proof of same to the Office, YES O NO O 11 you have checked YES, please indicate the type of coverage Dy cnecking the appropriate box. 7-18-200 2 INSURANCE BOND O OTHER O (Please Specify) (E=p,rauon Date) Estimated Value of Electrical Work $ work to Start Inspection Date Requested: Rough _ Final Sighed under the Penalties of perjury: FIRM NAME MDF ELECTRIC INC. Llc No. A12376 L censee MARK D. FIALKOWSKI —Signa . _._ uC. NO E28618 3FELTON TERRACE PEABODY MA 1 Bus. Tel. No 9 7 8-5 3 2-17 4 2 0 960 . :•ddross Alt. Tel. No. _ OWNER'S INSURANCE WAIVER: I am aware that the Licenser. doe; not have the insurrnce Coverage or its Sub5l3011af eq Uivaiant as is Cutruci by Massachusetts General Laws, and that my s,gnaluru on Ini; purmil application waive; this requirement. Ownur Agent (Please crwek ono) Tolopnono No. •- -.....�_-- PEAMIT FEE 15_OO (Signature of Ownor or Agonq