HomeMy WebLinkAboutMiscellaneous - 639 WAVERLY ROAD 4/30/2018I
IC -11
0
N.)
6
C, 0
PO Box 55098
I Boston_, MA 62205-5098
617-951-0600
Fonn of Notice of Casualtv Loss to Buildin
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To- Building Commissioner or
Inspector of Buildings
City Hall ,
NORTH ANDOVER, MA 0 1845
Board of Health or
Board of Selectman
City Hall
NORTH ANDOVER, MA 0 1845
RE: Insured: JOSEPH AMARAL and SUSAN AMARAL
Property Address: 639 WAVERLY ROAD, NORTH ANDOVER, MA
Policy Number: HMA 0308424
Claim Number: BOS00061463
Date of Loss: 3/11/2015
Company: Safety Indemnity 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, Chqpter 143, Section 6 to be
applicable. If any notice under Mass. Gen. Laws, Chgpter 139, Section 3B is appropriate, please
direct it to the attention o f the writer and include a reference to the captioned insured, location,
policy number, date of loss and claim number.
Lisa Monette Claim Examiner 5/28/2015
Safety Insurance Company
Homeowners Claims Unit
P. 0. Box 55098
Boston, MA 02205-5098
Phone: (857) 233-8618
Fax: (617) 535-5833
Email: lisamonette@safetyinsurance.com
9962 Date...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ................. A. �,�R D/ .......... . .......
has permission to perform ...... ...........
wiring in the building of ...............
...............................................
at ...... 4.3 -�- ZiMV&-rZ.K. .... t ................... . N, rth And Mass.
ol
6 ......... -10W .............. �?170vo,
Fee .... Lic. No.!iO52 .....
i - i -CA
Check # D, INSP . CTOR
11
Commonwealth of massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Use Only
Permit No.
Occupancy and Fee Checked
tev. 1/07] (leave bl-1A
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK'
All work to be Performed in accordance with the Massachusetts Eleeftical Cod
�e PAEC�), 527 CMR 12.00
(PLEASE PMTEVINK OR TYPE8,ALL JNJVF0 TION) Date:
City or Town of:
s
,Ive e Inspo ctor of Wires..
's.no/
*d of
By this application the undersi e givesno WA To th
0 of his or her Intention to perform the electrical work described below.
U �_. , " I _1 ,
Location (Street & Number) t> %-,
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit? Yes No
Purpose of Buildinp, Q-,' \,D 7-- 1-1
I- —I -\-4 1 - Da3 J\ Utility Authorization No.
Existing Service Amps Im
volts Overhead UndgrdE]
Lew Service Amps Volts
Overhead UndgrdE]
Number of Feeders and Ampacity
El BLDG -PERMT 9
Location and Nature of Proposed E�Jectrical Work:
V
No. of Meters
No. of Meters
No. of Recessed Luminaires
CO2LPletion ofthefollowing table may h waivedbytheAny
, pector of Wires.
NO- Of Cefl.-Susp. (Paddle) Fans No. of Total,
No. of Luminaire Outlets
No. of Hot Tubs
Transformers KVA
Generators KVA
No. of Luminaires
Swimmingpo I-
ED] 0.0 mergency ig Ing
D
No. of Receptacle Outlets 'o'\
grud.
No. of Oil Burners 9 Ild.
aite units
No. of Switches
FLU ALARMS No. of Zones
No. of Gas Burners
No. of Detection and
No. of Ranges
No. of Air Cond. Total
Initiatin Devices
Tons
No. of Alerting Devices
No. of Waste Disposers
JuvaL-rujmp :�!.!j P.g..1.1o.n.s
....... .. .. ...... ........ ..............
Total I.-
No. of Self -C ontained
No. of Dishwashers
Space/Area Heating KW
Detection/Alertin Device
LocalE] Municipal
No. of Dryers
Heating Appliances KW
Connection El Other
Security Systems:*
0. of ater
Heaters KW
No. of No. of
No. of Devices or Equivalent
Si s Ballasts
Data Wiring: 1
No. Hydromassage Bathtubs
No. of Motors Total HP
No. of Devipaq nr Prtyi;' .1 ut
i—ItTummunications wiring:
OTBER:
- No. of Devices or Equivalent
5 73
Attach addit! r
Estimated Value of Electrical Work: ;!4 or as required by the inspector of Wires.
(VVheii required by municipal policy.)
Work to Start: Inspections to be requested in accordance with NMC Rule 10, and upon completion.
'NSURANCECOVERAGE: ITpless waived by the Owner, 110 Permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation�l coverage or its �ubstantial equi�alejat. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND El OTBERD (Specify:)
lcerto5y, under t�_epalns andpenaltles ofperjury, that the information on h s app ca on ue and complete,
FIRM NAME: V�Cjai�r t! is tr
Licensee: ( LIC. NO.: A8��p
�z Signature',\c,�.,L.,
(If applicable enter
t LTC. NO.
exetnp in license number line.)
Address: Bus. Tel. No.:
*Per M. G.L. c. 147, s. 57 Alt. Tel. No.:
-61, security work requires Department of Public Safety "S" Licen 7
OWNER'S INSURANCE WAIVER: I am aware that LIC. 1%
the Licensee does not have the liability insurance coverage normally
required by law. 13Y my signature below, I hereby waive this requirement. I'
Owner/Agent am the (che 01100 owner
D owner's agent.
Signature Telephone No.'
ELECTRICAL PERA41T NO. INSPECTION REPORT:
ELECTRICAL INSPECTOR - DOUG SMALL
Inspectors' comments:
DOOR TAGS ARE TO BE FILLED OUT AND LEVT ON SITE IF THE AREA TO BE INSPECTED IS NOT
ACCESSIBLE AND A RE -INSPECTION OF S50.00 IS TO BE CHARGED.
The Commonwealth ofMassaehusetts
DePartment ofIndustrialAccidents
Office of Investigations
d 600 Washington Street
Boston, MA 02111
UV immmass.govIdia
Workers' Comp ensation. Insuranve Affidavit: Builders/Contractors/ElectriciansfPlumb ers
Applicant information Flease.Print LegjW
NaMC)(B.usiness/OrganizatiorvTndividual).
Address:- \ "-k Gr -e, Y �r� IKZ�'
City/State/Zip: US C_-) \CtW Phone. #: ') I - '��) (�'_) ?
,�re,,You an employer? Check the appropriate box:
%P -dm a employer -with ��
4. 111 am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. E] I am a sole proprietor or partner-
listed on the atta&ed sheet. I
ship a -ad have no employees
These sub -contractors have
working for me in. any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
3. El I am a homeowner doing all work
officers have exercised their
right of exemption per MGL
myself [No workers' comp.
c. 152, § 10), and we have no'
insurance required.]
employees. [No workers,
comp. insurance required.]
Type ofproject (required):
6. 0 New construction
7. 0 Remodeling
8. 0 Demolition
9. E] Building addition
10. 0 Electrical repairs or additions
I L El Plumbing- repairs or additions
12 -El Roofrepairs
13.El Other
—L.Y apIJILUMIL 111a[ CnecKS UoX JFJ must also nj Out tile section below showing their workers' compensation policy information
Homeowners who submit this afffdavit indicating they are doing all work and then hire outside contractors must submit a new -affidavit indicating such,
lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' c omp. p olicy information.
fain an employer that isproviding workers' compensation insurancCfOr MY enpfoye6. Below is thepolley andjob site
information.
Insurance Conapany Name- CQ)M0XrCZ,
Policy 4 or Self -ins. Lie. #:,(,k
ExpirationDate: K)
lob SiteAddress, 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
fM8 UP to $1,500.00 and/or one-year imprisonment,. as well as civil penalties in the forna 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 t10 hereby CertifY under thepains andpenaltieso4perjury that the informadonprovidedabove is true and correct,
SigRature: 'n�-P
Off7clal use only. Do not write in this area, to be completed by city Or town Offt-cial
City or Town: Permit[License 4
Issuing Authority (circle one):
1. Board ofIffealth 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5—plumbing Inspector
6. Other
ContactPerson: hone
Date.. .
8 8 6
TOWN OF,NORfH ANDOVER
e
PERMIT FOR PLUMBING
'F / t7 /W<' C 4
This certifies that . . . . . . . . . . . . '-K- -0 - G. -�(* C'
has permission to perform ....................................
/00 /0'
plumbing in the buildings of . . . '
3 P
at ...... 2 . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass.
F 7/ :�� I c, 3 V
ee ..... Lic. No .......... ...... k .. .........
PLUMBING INSPECTOR
Check . 2 )-3
4
01VIrl 10100
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: MA. Date:, Permit#
Building Location: 6J(:;�o bf�klefl IV /�O' Owners Name:
Type of Occupancy: CommerciaIE] Educational[] inclustrial[] Institutional[] Resiclentialk�4�
New: 92/�Alteration: [:] Renovation: F] Replacement: 0 Plans Submitted: Yes F1 No El
01VIrl 10100
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes [] No F1
If you have checked Yes, please in cate the type of coverage by checking the appropriate box below.
A liability insurance policy V Other type of indemnity E] Bond El
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 Owners Agent Owner 1:1 Agent Ej
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 ofmy
Knowledge and that all plumbing work and installations oerformed undpr thp nprmit iaa.—f f.r fh i. ...III �- I- - - - - --- ..
F-1-- - atine riumoing uoae ana t;napter 142 of the General Laws.
By Type of License: &� &��
Title El Plumber eignature of Licensed Plumber
Cityrrown El Master
APPROVED (OFFIC17 LJAF nN1 V1 Ofturneyman License Number:
DEDICATED
SYSTEMS
Uj
z
In
be
z
0
>
CA
z
In
cc
LU
z In
In CA >-
z he
IX
LU
IX
(n Z M
0
0
cc
a
Z
a:
LU
R 3: In
co
X
V)
R z In
In W W
= cc R
Z
in
0
Ln LU
0 j
0
Ly 13 z
In 0
=gW01--
00 Xz<U.?:M�d<X
=
a
Z
M
-j
d U.
= W =
LU U
=<<4ALn00!=:)>000z-
X
0. 1- U
Z
X
<
I.Auj<(A
< co 2
U, 1
0
X -j
0
< W
<
SUB BSMT.
BASEMENT
ST
I FLOOR
2 N' FLOOR
ID
3 FLOOR
4 TH FLOOR
STH FLOOR
C" FLOOR
T"
7 FLOOR
8T" FLOOR
Check One Only Certificate #
Installing Company Name:
El Corporation
Address: City/Town: State&
F-1 Partnership
Business Tel: Fax: ElUG-Mompany
Name of Licensed Plumber:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes [] No F1
If you have checked Yes, please in cate the type of coverage by checking the appropriate box below.
A liability insurance policy V Other type of indemnity E] Bond El
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 Owners Agent Owner 1:1 Agent Ej
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 ofmy
Knowledge and that all plumbing work and installations oerformed undpr thp nprmit iaa.—f f.r fh i. ...III �- I- - - - - --- ..
F-1-- - atine riumoing uoae ana t;napter 142 of the General Laws.
By Type of License: &� &��
Title El Plumber eignature of Licensed Plumber
Cityrrown El Master
APPROVED (OFFIC17 LJAF nN1 V1 Ofturneyman License Number:
N
The Commonwealth ofMassachusetts
I
Department of IndustrialAccidents
have hired the sub -contractors
Office of Investigations
)isted on the attached sheet. t
600 Washington Street
These sub -contractors have
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
pplicant Information Please PrinfLeLyibl,
Name (Business/Organization/Individual):
Address: PC,, A of
City/State/Ziv: SAe
Phone 9: je�y
Are you an employer? Check the appropriate box:
1. 0 1 ama' employer with
4. El I am a general contractor and I
ernployees (full and/or part-time).*
have hired the sub -contractors
2. �am a sole proprietor or partner-
)isted on the attached sheet. t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5.0 We are a corporation and its
required.]
officers have exercised their
3. 1 am a homeowner doing all work
right of exemption per MGL
myself [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.]
employees. [No workers'
comp. i.n�urance required.]
Type of project (required):
6. n New construction
7. E] Remodeling
8. n Demolition
9. F1 Building addition
10.E] Electrical repairs or additions
11.0 Plumbing repairs or additions
12. n Roof repairs
13.F1 Other
*AilypLpplicantthat checks box# I must also fill out the section below showing their workers' compensation policy information. '
t Romeowner*s who submit this affidavit indicating they ar'e doing all work and then hire outside contractors must submit anew affidavit indicating such.
TContractorsthat check this box must attached an additional sheet showing the name of the sub -contractors aiid their workers' comp. policy information.
I am an employer that is providing workers' compensation insurancefor my employees. Below is thepolicy andjob 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 Se6tion 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 forin 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 staternent maybe forwarded to the Office of
Investigations of the DIA for insurance'coverage verification.
I do hereby certify under the pai I enalues Wpeiyury that the information pro vided above is true and con-ect.'
Si_Rn ure: Date: 3 -- 0--
Offt"cial 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
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 ajoint 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. Howeverthe
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 deerned 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 subdivisio*ns 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 y6ur situation and, if
necessary, supply sub-contractor(s) narne(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmationof 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 req�ired to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate -line.
City or Town Officials
Please be sure that the affidavit is * complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the pennit/licensenumber which will be used as a reference number. In addition, an applicant
that must submit multiple,,permit/license applications in. any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Jo.b Site Address" the applicant should write "all locations in (city or
town)." A copy of the affid avit 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 pen -nits or licenses. Anew affidavitrnustbefilled out each
year. Where a home owner or citizen is obtaining a license or pen -nit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The, Commonwealth of Massachusetts
DepartmQnt of Industrial Accidents
Office of Investiptions
600 Washington Street
Boston, MA 02111
Tel. # 617-7274900 ext406 or 1-877�NMSSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
-4
Lrl
ON
ro
Lrl
>
-4
Ul
T
cz
0
z
'n
a
0
>
m
0
=1
z
C") 0
Fn
cn
m
(D
q
;K o
Icl:l cn
> CD
C',
r
CD
o
Lrl
0 A
;o
C)
0
Is
r- 0
o >
o
IQ
�-A
z
M
o
z
Cl) z
_0
=k
o
N
m
0
(n
(n
>;
O.So
lea
Hill
co
Z
c
]Ell
li
I
..
M.
V)
Ln
4.:
CP
Cry
m
SigZuT
o -nim
'n (A m
,nO_M
Oc:>S,-
M-4r-I
Wn-�Ch
co;a m
-4
maz
CAMM
r- z
U) -f v OC -4
mz
m c 2
m WE o
M52 -1
wr
rn
? om>
M>oz
-4zo
=M>
rmou)
0-M
(A Z
MG)
Location-l"In U ce
No.
Date+4ks-
40
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
3 CHU
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
/;, 1.) $
Building Inspector
02/13/% 12:42 720.00 PAID
9401 Div. Public Works
Location (Oact
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$ t�>(-)
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
Building Inspector
5765 13:21 150. PAID
Div. Public Works
Location
(003 Date /1-4-"—�57
ro
/11"00.RY
0
� 7�
TOWN OF NORTH ANDOVER
-!V . . , a
Certificate of Occupancy
Building/Frame Permit Fee
$
$
CHUS I
Foundation Permit Fee
$
Other Permit Fee
$
/Cz)
Sewer Connection Fee
$
$54�
Water- Connection Fee
$
TOTAL
$ 6,b
3 Build
c or -
11/27/95 13:21 PAID
8991
Div
lic Works
lic
PERliff NO.
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE I
MAP i
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK 'PAGE
7,ONE
SUB DIV. LOT NO. J. -A
LOCATION
PURPOSE OF BUILDING u
tcAoa )I ICA.a-
OWNER*S NAME
NO. OF STORIES SIZE - -I--
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME C(-%vc L<v)
SPAN i 2,'
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET 4 -
POSTS
DISTANCE FROM LOT LINES SIDES REAR 7g
IS
GIRDERS
ax 1.7
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x -z- C)
IS BUILDING ADDITION
MATER:AL OF CHIMNEY v
IS BUILDING ALTERATION /U o
IS BUILDING ON SOLID OR FILLED LAND Sx, (Id
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ye -5
IS BUILDING CONNECTED TO TOWN WATER -(e5
BOARD OF APPEALS ACTION. IF ANY *,>
, VA&fhifvC��
IS BUILDING CONNECTED TO TOWN SEWER - -,t�
- �jf
-
—C(4-
1 IS BUILDING CONNECTED TO NATURAL GAS LINE 4tt�S
Aj2Mt )�"�eUCTIONS
TF�-
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS I - 3 PERMIT FOR FOUNDATION ONLY
REGULATED BY PARA. 114.8-S. B.C.
PAGE 2 FILL OUT SECTIONS I - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING DATEI-4"- )&-FEE PAID -Loo -
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONd
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE rILED �w%
'SIGNATURE OF OWiA G;'ZTHORIZED AGENT
IF E; E;
PERMIT GRA
DATE: -FEE-
19
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. Fif.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
OWNERTELJ
CONTR. TEL. #
BUILDING
c,,7 (
CONTR. LIC. # 100 5) q
H.I.C. #
cli
BUILDING RECORD
I OCC UPANCY 12
SINGLE FAMILY
SiORIES
MULTI. FAMILY
APARTMENTS
CONSTRUCTION
2 FOUNDATION
CONCRETE
8 INTERIOR
FINISH
PINE
a
1
2 13
CONCRETE BL*K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
-6RY WALL
UNFIN.
3 BASEMENT
AREA FULL
1/1 1/2 %
FIN. B M T' AREA
FIN. ATTIC AREA
NO BMT
HEAD ROOM
FIRE PLACES
MODERN KITCHEN
4 WALLS 9 FLOORS
CLAPBOARDS
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
B '
.1
2
3
-CONCRETE
EARTH
HARDXI."D
COMMCN
MidlIP. SIDING J�i��L
ASPH. TILE
STUCCO ON MASOf4RY
STUCCO ON FRAME
BRICK ON MASONRY
ATTIC STRS. & FLOOR
BRICK ON FRAME
CONC. OR CINDEi BLK.
WIRING
1,111'
STONE ON MASONRY
STONE ON FRAME_
SUPERI Y� POOR
F O� V
QUATE NONE
5 !pOF
10 PLUMBING
GABLE
BATH Q FIX.)
GAMBREL
-t lip
MANSARD
TOILET RM. (2 FIX.)
FLAT
1�
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
wOOD JOIST
Y-1
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
H T W'T'R OR VAPOR
WOOD RAFTERS
4/
AIR CONDITIONING
RADIANT H'T*G
UNIT HEATERS
7 NO. OF ROOMS
2�
M T::� �d
YJ F3nd
GAS
OIL
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
01,
FORM U LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: A tvww �r HAVIOCE �&Itld'rKs Phone -)9q-3S 71
LOCATION: Assessor's Map Number Parcel
Subdivision Lot (s) 15-A
Street St. Number
************************Official Use Only************************
RECOMMEND#TIONS TO AGENTS:
' �177_,r
V
Conservation Administrator
Comments Ald WAf,6 f
ti. Af W�� Q it JQ N 13
Town Planner
Comments
Food Inspector -Health
4 zt��_ J
Septic Inspector -Health
Comments
Date Approved ///Off
Date Rejected
M
I a44/ -Flk -
._M2J A
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved hr
Date Rejected
Public Works - sewer/water connections -q-LL) / L16 -2 5-
M
Fire Department
Received by Building Inspector
Date
Y/1:1r
Any appeal shall be filed'
within (20) days after the
date of filing of this
Notice in the office
of the Town Clerk.
APMO
TOWN OF NORTH ANDOVER
MASSACHUS=S
BOARD OF APPEALS
NOTICE OF DECISION
BK 421281-
JONI 40
A
DEC 16 AN 1%
Uiat twen:-: (20) days
_;ap3ed from data Of dOC1610n M9d December 22, 1994
LoAl Date ............................
..."I filing of ;n 6��_ - -
Dal; 72W -ZlAd Y 4�—
A. BFUMM Petition No.. 0.6.1.- 9 4 ..............
D ate of Hearing.Decembe.r. .13,.19.9.4
....... ... ..
Petition of . . 11enry G, . Bernbe aud. Una M. . Berube ......................................
Premises affected .633. Way'e.rly. Road.,. North. Andover,. MA ...............................
Referring. to the above petition for a vanistion from the requirements of tkix . Sectio.n .7 ......
:F4ragraph .7-2,.7,3. and.Table.2 of. the. Zoning. By1aw ............................
so as to permit a front. line.variarice.of.20. feet. for. Lot .#I,. a..f.rqnt. linexarianc'e
of 20 feet, (north) side setback of 5 feet and (south) side setback of 8 feet
f or Lot #2,. And . a. f ront. variance. of .20. f.e.et f or. Lot. A3 at. the. premises. at .......
633 Waverly Road.
After a public hearin.- given on the above date, the Board of Appeals voted to . GRANT..... . -the
Variance.as..r.equested .... ..... .. and hereby authorize the Building Inspector to issue a
permit to Henry G. Beru.be and. Edna M. . Ber.u.be.. .. ................................
!--r the construction of the above work, based upon the following con�tions:
The Board finds that the
petitioner has satisfied the
provisions of Section 10,
Paragraph 10.4 of the Zoning
Bylaw and that this variance may
be granted without'nullifying or
substantially derog�ting from the
intent or purpose of the Zoning -
Bylaw.,
ATTESM
A Mue Copy
40" a (40AA".
Town Clzrk
Signed
... willfini j. 8u,l1:i,;a*n" * diall�iain
Walter Soule, Vice -Chairman
koib'e'rt'
John Pallone
'8c'o't't' 'K'a'r'p'in's'ki ...................
............... .............
Board of Appeals
M
M
I
x
Z
0
Sao
0-L
TOWN OF NORTH ANDOVER
MASSACHUSETTS
BOARD OF APPEALS
Henry G. Berube
Edna M. Berube
633 Waverly Road
North Andover, MA 01845
�dzol ri.3 -42o
IVED
JOYCE 6ADSHAW
TOWN CLERK
NORTH ANDOVER
DEc 19q
DECISION
Petition #061-94.
The Board of Appeals held a regular meeting on Tuesday evening
December 13, 1994 upon the application of Henry G. Berube and
Edna M. Berube requesting a VARIMCE under Section 7, Paragraph
7.2, 7.3 and Table 2 of the Zoning Bylaws so as to permit a
front line variance of 20 feet for Lot #1, a front line variance
of 20 feet , (north) side setback of 5 feet and (south) side
setback of 8 feet for Lot #2, and a front variance of 20 feet for
Lot #3, from the requirements of Section 7, Paragraph 7.2, 7.3
and Table 2 of the Zoning Bylaw at the premises at 633 Waverly
Road. The following members were present and voting: William J.
Sullivan, Walter Soule, Robert Ford, John Pallone and Scott
Karpinski. The hearing was advertised in the North Andover
Citizen on November 23 and 30, 1994 and all abutters were
notified by regular mail.
Upon a Motion by Mr. Soule and seconded by Mr. - Vivenzio, the
Board voted unanimously to GRANT the VARIANCE as requested.
The Board finds that the PETITIONER has satisfied the provisions
of Section 10, Paragraph 10.4 of the Zoning Bylaw and that this
variance may be granted without substantial detriment to the
public good and without nullifying or substantially derogating
from the intent or purpose of the Zoning Bylaw.
Dated this 22nd day of December, 1994.
BOARD OF APPEALS
William J. Suftk�'an—, Chairman
71 W iq \Ni rr-- 2 u-)
FOu VA V Orr) 0 V4
'741 ?3
/2 D
* \M*/AA'/crr- P/47'e;o IZ-1oz-11914-
I HEREBY CERTIFY
THAT
THE 5HOWN
HEREON
/,I LOCATED ON TPE
GROUND
A5 5POWN AND -THAT
CONFORM5 TO THE
AN
BYLAW5 OF THE
1-1610-rp
-7#�9r 7/14.5 PP-4PO;e7.V A4
Jq n;=RICK M.
7-0 1;,VLAF
PLA 1\1 OF LAND
/N
A/40 7-/-;/ MJZ;V 1��/C
PREPARF-D FOR
AMPelcw �IIIM01214Z SU14-lw4es
5CALE: I"= IVO'
RURAL LAND SURVEYS
130 CENTRE 5T — DANVER5, AM.
(4
oll
CN
r -q
RYI
MA
cm c
Lo
CLS
>- cd
Cc C=,
r- tz C) C4
0 CIO
s
z C6
c 5
co
0 r.L
coo) LLJ
cj
E
'CO4
ca
Eg
CM
14
Cc
CMJ
C.3 0 E
CAG3
cm
cop) CD
LLJ
LLI E
L- C.3
Q.3 co 0
Cl) = CD -5 0 ;a
W3 LOD
rL.
LLJ
LLJ
z
0
C/)
4 -
CO
0
E
co
0 ca
co
LA
E
0 co
CL
co
>. CL)
CD
Q
C90 0
CL cm<
cn E
CIO
CD
ca C.)
co
CL
C4
"a
CA
0
0
u
u
z
z
z
:w
Lf)
C.4 C.)
Z
to
E
MA
cm c
Lo
CLS
>- cd
Cc C=,
r- tz C) C4
0 CIO
s
z C6
c 5
co
0 r.L
coo) LLJ
cj
E
'CO4
ca
Eg
CM
14
Cc
CMJ
C.3 0 E
CAG3
cm
cop) CD
LLJ
LLI E
L- C.3
Q.3 co 0
Cl) = CD -5 0 ;a
W3 LOD
rL.
LLJ
LLJ
z
0
C/)
4 -
CO
0
E
co
0 ca
co
LA
E
0 co
CL
co
>. CL)
CD
Q
C90 0
CL cm<
cn E
CIO
CD
ca C.)
co
CL
C4
"a
CA
CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number Date—
THIS CERTIFIES THAT
THE BUILDING LOCATED ON
MAY BE OCCUPIED AS IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO Lcg
Is
ADDRES, S7,,-
-I
P�j
CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number Date—
THIS CERTIFIES THAT
THE BUILDING LOCATED ON
MAY BE OCCUPIED AS IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO Lcg
Is
ADDRES, S7,,-
Crar CA
co) cm)
CO CC'Dl �11 CC,
=-o CA
m al
c=,,r c
't 5 ��
CD 0
=CD r C4
CD
0
:E c=D
a. CA
NIZ
CO to
0 z fc. CCU,
CA C") 0 CO).
a coo
CD
Cl) z CA 9C2
cc
C-* o = = -*%
D—
CL r- Cl) 0.,: 5 �
CD CO)
CD
-COD
CD
CA
>Cc
'00
Cr
C-) C
CD
CL
CA CD Cog
0 P—
CD :E CD
CA Q
CL CO2
CD
Cr CD u
CD a
cog
cl)
CD CD
0
a CD CO)
CD
E—L co') M
m CD
C= n
cc CD
CD
/* m
C�l ;w co)
CO) tz: C"
CD
0 co
rn
CD
4�, C)
boo
cl
CD
C�l
CD:
r&t:, � -
m
m
C/) C/)
9 -
0 CD
CD
rD
z 071
0
C/)
rD
n
o
CL
C/)
ID 21
0
r -L
v
tz
rp
0
tz
CA r) C)
rD ::r- >
E3 rD
o
1, 3'D
, NO
�mi
0
Iko R H
16
- it 6 0
Oct
coc
TED
cHusle�
APPLICATION FOR =_ TIFICATE OF OCCUPANCY /INSPECTION
ADDRESS/LOCATION OF P—VOP=--RTV-:. (o3q UL"
f
DATE REQUEST FI=D/RZADY FOR INSPECT=N: 3 196
CLOSING DATE ON PROP=--;=,':
FIVE (5) DAYS NOTICE' _PRIOR TO CLOSING DATE IS REOUI-IZEDo
ATT, WORK AND SIGN,—OF---S MUST BE =12HIPLETED W771HIN THIS TIME FRA'ME.
A RE—INSPECTION FEE OF TWENTY DOLl_XRS ($20.00) WILL BE CHARGED IF
THE STRUCTURE DOES NOT 3NMEET ALL APPLICABLE CODES.
S I GN`� �.'J
0
Ll
CN
DO
Cl
u i
LO
M I
$lip
C:==
a C=
I C*
00
Lq
0 C=
Cl
00
0 00 fr_
FF m
LLJ
m
Ple)
Milli CO
04
11 ILJJ U Lui U-
X
C***4 C-4-4
C�g
r- v
!40!
png
M.
m
pnd
0
I
I I W
IL
I
F'A
cn
*t9to V" luon4jan SHIVO.Z/i i — shoo�mo 2 c.,
co
IS JODUPAN 692 > ONIM 30VVO/NOO� �11NVJ n 1 04
sioping aounDn ;p MOJPUV d
NOSIMV9 2Z X Vz V)
2
C)
a
00
2
co
U)
0
C,4 _0
0
0
x
C)
0
_0
0 eq z;: --
00
C:
U)
Q)
U)
0
cu
!c -6 Q)
C�o
0
0 w Cc
0
a-
(A
-0
CL)
0
32 -Z5 L)
D
-0
-a
C'4
(L) L� -L
00 >0
co
-V
L)
a- (L)
oc
93 0,
C�
0
ou
0
-0
t
00
Cl
0
u
a)
0
04
ar.: -i--j
OL -144-
a�-�
CU
Q)
>
o
= c
o o
L --- j
(D
En
=3 E
0 Q
:5
E
1 r, :, r�
u 0
.5; c
o
0-- = -a
CD
cu E
— 0
cu
a E
CD -a)
0 -0
7&< M
CD
—o,2
u
83,
N
0 E 0
0
W
V5
E
c�
ui r-
0 a) CD
0
J -Z
oc
-'0
a-
.
U)
Q) b a)
En
o
-�-j
> >,
u
o E
u 5,
- OL
C:
0
Q) cj
C"
on 50
0
cu
no_- o
-0
(u :8
"0 f
o
CL 1.0
0
0
a) o
u
a)
n- 0 .2
0
la- M
��N
cf.)
CD 0 (n po
o 00
E E L)
o
rg
uo
LJ 2
2
0
U) Q,
La
0
-T� -
,
-,'--,o ow, C�
t;
Q)
-4-J
(on,
C',
-go,-o.
Q.)
cn
C:
0
§ -0
0
-4-
Ua L)
C,
E 0
0
-ui c
�g 0
E
0)
cn LF3
(,,u
Q)
No 0 L60.
0
1E rvn)
0
C: cu
U -4-
Cn
:3
0
0
C)
w E
lie
Lw
-0
(U
w
10 cu"
w
E
0 0
E ---j
cu
-+-
E
(cou c(no
Lo
0 -C
-W
-
-0
<
:3 CD
< M -4-
<
:3
cn
o
L-
O.c 0
< a
0
00
0
C -i
.6
06
2
C)
a
00
2
co
34#011
22T 12'0"
19'6" 2161t 3160 51011 316D
co
—Z
1
-.
x
,
4
A
CD
9 -
CD G)
0
cx m
cx
0
0
00
__z
C:)
co
3'5- j
T
C)
A —Ti
(D
06
C� 3
m
P�Flv
KY- CT
r
<
G)
0
C)
C5
4" 4T
510y'
31010
:rE 0� L> G)
cr C3 —TI
0
o 0 00 )> C)
2- Ln r -L Q
23.-,,o M
0
V) =3
U)
o
CL CD -, 00
CD
in- CE
V)
.494E C)
co
co CL
CL C -j
CD
5
OD
-Z
4e
OCT
0
3'4/4" 2'4" 6'2
If 20610 T T
L4
__z
2-26
CrT
4N.
C) co L4
0�
410" SHANG b\:— 4 0
CL
00
C6
3
C)
C�
00
0
cr�
G')
6'0" 6'0"
1 —
12T 12 on
24'0"
1
-.
101-
,
4
A
A ( I A A I . '" , . , I I I I
ACL
"O,ZL
CN
.9,6
CC)
CD
LLJ
CD
CN
LO
0
r-,
LO
0
0
0
C�j
C-4
ry
- - -
- - -
- - - -
--
A
Cy
LLI
LLJ
m
m
,9,L
,
r
LO
Az
C-4
00
CN
z
Az
of*
00
C14
C-4
CL
"Z,OL
-T-
.J,.9
C:)
0
cn
m
LO
114
ONIOIS .0,*
C)
0
11SMO
00
L
041
-.4-
-L
Ole
O,g
.9,9Z
0
MO
-a
0
41
-9
CD
4.1
31-
C�i
>
0 0
—v)
3. 0
-0 -a
0.6.
A?
E w 9 0 "�
S2 ite
r
4)
0 0
0 - Q
4-
0-
0 -
0.9
u E
>
0
CU
ou
0
0 a) ar.:
u 0
E oo
C2-
CD I-" d)
0
.r. 0
_0
>
-a
r -
=.a, 0
E 2c,4
.Q
MCI
C�
C14
E
u E
0 a) 0
-S cc v)
'6 c
E 6'�--
a)
cQ -0
0 4)
L) CD
E 0
-0
=.n -8 Co
-0 0-0 a
C 0 -0
E G E �4-
0 1--)
oo Or
d)
m
2,0
o
= -I--
a to a CD
E c14
10 V)
A.
0 D—
a
c
�0; E
<
o 0
E (D
C) C>
04 12 'd-
f 0 E
r-
L.LJ
o mw
pe)
0
Cc) 0 a
E! r-
u
v) Z5
>,cn a)
V) > C)
0
-
(D
D-
0 a)
LLI
u
c 5 -a
o F-
o
n-
0
a—
C14
N 0) (D
r- -2
;it >11.4.
a r n
4)
E 0
IV 0
IM 0
>
-2 E CD 0
:5
E
0.6.
E wo
co
a 'am a ol
U3
c
a 0 'o-!5!
E 'a. (u
a) V) a)
-W c c
C6 CD
CU
L-
o N
0 -0 C)
= r -
CD
E to - w K)
0 to
>, CL w
0 0-0
0,
--j a cz= cn
0 0 n
I
C-4
Ki
4 ui
A ( I A A I . '" , . , I I I I
22'0 "
171811
mm�; �
4
121011
51011 1 3'6 0
N)
C=T
cr�
a
I ----------------------------------------------------------
rT ------------- TI
I
-------
F-------------------------------------------------------------
J: ----------
-W
-. !z w -.
;,
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - -
- -
- - - - - - - - - - - - - - - - - - - - - - - - - I
1w Ir
. . w
CO
0
- w . . 1w 1w
f
I
)L
0
1 '06
--------
--rj
C) C)
9 9 0
1 :0
3
-- -------- J-4
un
1:0
4,
cc 0" 00
2 ca
-Do
x =
0
-
0
0
M
o� =
-TI
it.,c
Cn
C-) Z:
0
0--o
Co 0
rt.
0
--+.
0
0
4� Concrete Slab
m
>, CL
06
r+I
00
-T
CD
Slope 1/8x per foot
0
M
0
cr
(D CL
0
M
0
IL
CL
CD
I
N)
C=T
cr�
a
--.0
CD
(A
00
r'%%3
Ul
I
12'0" 1 610" 1 6V
24T
k,
I ----------------------------------------------------------
I
-W
-. !z w -.
;,
1w Ir
. . w
.
- w . . 1w 1w
)L
------------------
1 '06
--------
-- -------- J-4
L,4
06
IL
L4
0
�E
to X
(D
CD
CO
(D
cri
Na
C)
co CO
R* g-:
C6
u- CD N -
(=D
CD 0
0
bP
25*
--t6
=3
CD
49811
-40
0 (/)0)
a)
C=T
ZE
m
CD
,4-
CD
0- x
CL CD
-0
CO
ro.
-n
?5' a)
-0
C)
77 *
0
x
M
W x
CD
CD
U)
=r
CD
C),
CA in:
CD
L------- -----------------
---------------
:4
--------------------------------- 4
----------------
I
--------------
--.0
CD
(A
00
r'%%3
Ul
I
12'0" 1 610" 1 6V
24T
k,
z
.. 49,L
Im
d,
0
=3 IM
ol -
LO
o
m
0:5
(a
rn
011-4-
0
0
00
-C co
0
co
x
'a,
0
-a
0
t, to
3c o
C/)
-04
9?
D
04
> 2 rn
0
00
E m�
o C: >
-0-5
c S2
PO
!�-
C>
E
:2:
0
BI: 3:
"r-
. -4-
0 0
al
ro
-0
0 A?
0 (D 0
— -0
C�4
X C
75
4)
CN
(DR
-4-90
a)
00
Q)
6.
3:
M 0
0
IRP =3
<
m
x
c
w E 0
i. "
>
-j
6-1 L- 3:
C71 b .w
M �2 02
W J2
m
C14 *5 Ipp
Z:
0 rL
n
- E
=
oo
ZE
<
CN >< :3 CLC -4
CO a
__j
a C.4 (33
1 0 '-,(b
ol
C:) -p
0.24--
0,+-o
0
o
V) < C'14
a
L.. V) 1"
0
C14
E
-;d
0 0 0
= a U-
a (D
a
0 Co 0
E -o 'r-
z
.. 49,L
Im
d,
LO
o
(a
rn
011-4-
C4
04
0
0
-C co
can E
ro
'a,
0
-a
0
t, to
3c o
0
:Pd
-04
9?
D
CD
> 2 rn
d)
-0
E m�
o C: >
-0-5
c S2
PO
!�-
0
0
0 :r --
"r-
. -4-
0 0
C-4 co
-0 4)
ro
-0
w
cr C14
V)
-0
75
4)
CN
a. 0
-0 a)
�o
c >
0-0
6.
C:)
(D
c
-o
w E 0
i. "
0
0
(D 0 0
C14
- SQ .10
W J2
c)
:3 a
n cr E
-r--
- E
=
oo
00 0
o-
—
-.t=!
or
01 0 CJ
-a
c
0) 0 E
0 :3
oo
d) "
-0
0.24--
0,+-o
0 L)
+, a
CL
o
X d)
= CD -0
a
L.. V) 1"
Ja t
9) a).
2 -r-
C14
E
-;d
0 0 0
= a U-
a (D
a
0 Co 0
E -o 'r-
a) 0
4- 0
a 0 0
0
6
0
E :5
0 g,, E
00
C-4
a
;G
E
0 (D
L-
co
a—
W
o . -
-P- =
:3 E
cr w
0
0:5
0-0
a) 0, :p V.
:3 r
C-4
0. .
0
:3 4- a
0 -a
0 V)
L- 0
u
c
cr-,,-
0 L -
(U
'a cn
-2
T
(D
E E
"D
co o
CD
> -0
C:
4) =
co r-
0
0
0 -0
0
0 a—
or- a
-2 a
0 > CU
co
0 L-
0
0 :3
00
> 0 -a
0
o "hto
2 S
> 0-0--
0
Q
0 Ir
-5 0
.0-0
a
co c)
cn 0 -0
c)
"
CL
-W L" -a
0 r-
ty, "a
Q (U
L :3
E
0
-
a
CD
<
ca
ry -0_0
o) 0
-C (D
a E co
39
E C4 CS
:3 � rO
0 ;Z
0
L) E
a o
o
.160.
"Cl E 0
4.1
w
0-5-0
p AQ w
b..
q? u
:3
0 W.E
C�
0=
oo
W 0 CO
01 Q -0
r. :E
M.SQ
E 76 V)
I= C'�.
a—
-G
>
CD 21
co
a) 4- c)
>
92
_n
> E
Z: w
-a L: -a LO
E -a
:3 w w
a 0
3t: -C E
0
J2
+,
0 0
Ll
5D
F— O -o 0
fQ
r. 0 %4--
0 o W "4-
0 K)
4) 0 0
-"
75-S 8)
9) x
t>3 (D
M
4),o C14
0 r to
0
cq Q::
c
M cn 0 t.
-,j -C-
V) " M.
-0
tt
ul 'a
to
0
31:
Lu
V)l
C%4
mi
4
ui
C6
z
.. 49,L
Im
-4*
G)
V) Na 0
P -t- 0
co
cr a
>
M
OD
N x
0
=1
0 < 0
coo
4 0-
G-)
La
a
CO M 0
rL LVI
0
m
m
0 E� c
0 Lim
7v CD
CO3 :3
r.. rot-
C;
CO
0
CD C:
rL
U)
CD
CL
CD
CD
co
<
CD
M
LO
lxz
L
0000
--0
>
> ;10
0
C:
00
x
CD
>
0 C
X 0
:3
V- -1
o
(D
5; a -1
G-)
CD
�5
TNI
0 (D cl)
C-) 12L
0
00
>-
q
Sr
0
0
0
La
CD
0
4m 0
go
co CL
\yr
CD
CA
co
CD
00
C-4
co
LL.
x
04
co
x
N M
0
'o
"Go w
co
- - - - - - - - - - - - -
to
le 'r. -
x xx x xx x xx
N C4 N N IN N N N N
— - 1 92 1 ��4
V co cc
it C-4 S2 $2
E e LL- io - —
S S �i
x x x x x x x
u3
94 N 04 C-4 04 04 IN
a EL $2 to NO $2 7
0-0 -c� '" m (n 1-1
E -0 uj -S- 1� T
(n M -c Q 'o 0 C-4 E LLJ tz N. 52 Lr) 0
-j x x x x x x
10 Lo- .40, C4 N N N CN C-4 v
< 2 Q Z <
0 d) -o 6: < .2.
V)
Z12 eq 52
EZ 0
!tj 0 LL .0 0', > J- 00 9 c
0 4� 'T E-
0
!Zl .8 EL x X Ic x x x x 4)
—i V) E4 C-4 c4 94 N N C-4 lz CX4
C) 0 0
A 0 N Se 40
V
r-.Zg E! - 0
e " M S S %�2
-15- 1 -.0- -d- 45-
0 �'b 1, J� Z) 4-4 5;�.
0- d) L: en F x m K m x
CL N C4 04 IZ CX4 CX4 lz LL
9
C-4 6- x '0 o r
6 IS I 'o 0
, t 9- 0 < 0-6 8
>< LL' Sr Q 13 'o- I = t -
L 0
L M <
'w 0
CIS
8 04�
a 0 0 S.21 S2 Plr El 0
NO 009 V I -- 1 0.
F. 1.8 0
a (n E > 0 V) V) < Noo M 0
xxxxx cn."
'6 IN C-4 C-4 IN C4 C4 H 4 A C4
C4 C-4 C4 C4 C4
6- x
0
CL clq OLD
C*4
cj
11c,
co
Jl
/f I -TT
CD
x
cq
0
IL
0 L+
P
I a I I
1008 JaNkol
4 . I P. 0 4 , .. 00 . .1 " 1 44 - , .1 � NO I . -,
OM
0
0 (xm
=3
05-9-0
:51
i =—
Ox
;PIZ
CD t::)
o
=r
0
co
0
1-+-
C4
x -, a
-P, (A
77
C) CD
-0 r -o-
a %R- o
(310 p
0 0
C:) CL r-
W-
Z:
CD
x
-P-
--i
0
0 x
0
-1 00
e,
0
55'
r-4-
0
x
00
ZI
3
C-
0
x
co
0
0
3
0
0
OL
0 Lf)
C-) C-)
a
C
0
>
rQ
CD
><
0
CD
0 x
0
-1 OC)
C- a
0
0
-#.-
x
co
C-
0
NJ
x
0
0
3
:E
0
0
0 Lf)
KL
CD
;:o
0
;:o
0
70
M:
;;o
0
0
--41
U3
CD
J'o K) r-.3
x
U)
R-
co
a I
M
co
70
x x
a! x
m
CA
-P, 01)
I< C-) -;N.
0 o
C-
o*
0 0
0
<
m
0
0
0
CD
0 -0
c—
0
C= 9,
W- CD
to
3
0
0
3"
zs: o
r-Qj
x
x
>
>
D
#-*7
CD =3
CA
=r co
CA
< c
(D 0
co
CD
w
m
CL
a
0
CD
a
=3
to
CD
CD
C)
C)
C)
C>
Ij
x
C—
0
_0
P ;<
x
CD >
CD
CD
CA
IT
rA
77
o
CD
14 -
OIL
CD
0
co
-4-
0
0
Ni
CD
CA
00
qq1 I.,
Off" use,,��/xl
01 4t 60WHIP11mato vf Muguf4uttw Permit No. !3?
I)cParlwat of Public bufall Occupancy,& Fee Chocked
3M peave blank) � �TT
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 122 1 T
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL PRK
All work to be performed in accordance with the Massachusetts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INIfIORNmPE ALL INFORMATION) Date I /9-3M(cn.
City or Town of N- To the Inspector of Wires.
The udersigned applies for permit to perform the eloctricN work described below. r
Location (Street & Number) ln-�L!a Sentry- QOde<0—);1q
cixcuit 0
Owner or Tenant
Owner's Address
Is this permit in conjunction with ct building permit
Purpose of Building
Existing Service Amps Volts
Now Service Amps Molts
Number of Feeders and Ampacity
Yes El 'No 91 (Check Appropriate Box)
Wily Auftrization No.
OverheadE) Undgmd El No. of Motors,
Overhead 0 Undgmd El No. of Meters,
Location and Nature ol Proposed Electrical Work LOW VOLTAGE 46T.ARM SYSTE-121
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
gmd. El gmd. 1:1
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Unfts
No. of Switch Outlets
No. of Gas Burners
FIRE ALAPJAS No. of Zones
No. of Detection and
No. of Ranges
No. of Air Cond. Total
tons
Initiating Devices
No. of Sounding Dervioces
No- of Sell Contained
No- of Disposals
No.of Heat Total Total
Pumps Tons KW
No- of Dishwashers
Space/Area Heating KW
DetectiordSounding Devk4s
Connection
No. of Dryers
Heating Devices KW
No. of No. of
—LOW Zlllurg 0 Fre
No. of Water Healers KW
Signs Ballasts
Wiring 0 Card Acom 0 CCTV
No. Hyd(o Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Puts ---ant to the requirements of Massachusetts general Laws
I have a cur(ont Liability Insurance Policy including Completed OPOMIJOns Coverage of its substantial equrvalanL YES 0 NO 0 1
have suUmiltod valid proof of same to the Office. YES 0 NO 0 It you have chocked YES. please Indicate the type of coverage by
chocking the appropriate box.
INSURANCE (X BOND 0 OTHER C; (Please Specify) Royal Tnsur-anc-g- CCUpapy 10/8/917
(Expiration Date)
A,T-ni ()
Estimated Value of Electrical Work $"-�
Work to Start Inspection Date Requested: Rough
Signed under the Penalties of perjury-.
FIRM NAME .19P-nt-rV Tnr rJ -ni PI -t -imp Syst-
Ibla Rim -y-v 16rni- FMTL9 UC- No. 1109 C
Licensee James W, I-Ae� Signa,��.5, aaaa —uc.No. 000080 Mblic
Bus. Tel. No. 617-388-M Saf at -v)
Address 110 FlCrenge Sb7eE#-- Malan Alt. Tel. No.
OWNER*S INSURANCE WAIVER. I am aware that the Licensee (joqs not have 1,116 insurance cOvOrage of its subsMnLtal equivalent as re-
quired by Massachusetts General Laws. and :hal my signature on this permit application waives this requirement. Ctivnw
Agent
(Ploaso chock one)
Telephone No. PERMIT FEEts, Z�6
(Signaluro of Owno( or Agent)
Date .......
TO
14- 684
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... LA .... i .. ...... "'?.Y ............... 1 ....... .............
has permission to perform ....... .. af�.IP ........ e! .. >'/� .....................
wiring in the building of ....... -A. i'm R. �e.a ..... t ..............................................
3 North Andover, Mass.
at ........ f ...... ........
Fee..,,).L 0
Lic. No..... ...........................................................
ELECTRICAL INSPECTOR
35. 00 PAID
12.
WHITE: Applicant CANWVIiding ept. PINK: Treasurer
ly
office use onq
C1 (r.=umman of ffiassadpmetts Permit No.
Jepr=rnt af Vtthift —Aafttg C=pwcy & Fee Checked
7 CMR 12:00 Veave bla2nk)
BOARO OF RRE PREMMON REGULATIONS =5
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in ac=rdance with the Massacr.usetts Electricai Code, 527 C IR 1 .00
5
Date
(PLEASE PRINT IN INK OR TYPE ALL INFORIMATION)
=Q or Town of --NORTH ANnOVER To the Inspector of Wires:
The udersigned acpHes for a permit to perforrn the eiec:ricai wiork-0es,cribed below.
Location (Street & Number)
Cwner or Tenant
Cwner's Adcress
Is thts permit in ccrijunc*ion with a. ilcing cerma: Yes No (Check Apprccriaze Box)
P,.jr=cse a,, Buiidirc A� Utility Autt,,crization No. 06 ado S,-3e:F—
=-is* Cvemeac Unccnd No. of Meters
— ing SerAce Amcs "Bt 1 '�IZY4 'Icas Cve!'"e_=cer No. at Meters Z
Ne%.j �Zervicq ir,_� Amola Uncarna
Nurr-cer at =eecers anc Arncac:ty
arc Nat,.;re =rcccseC Elec*r:--2
L.q:I-Ing Cuuets a. :4 �a: --=a
otat
No. �-r -,anslorrners
.No. :;t Lgriting =-xlureS Swiniming �=i
Generators KVA
No. of Emergency 7_91"11111,g
14c. 21 ��ecevac:e CuVets Na. V Cil B'.;.nerS
Sarer�, Units
No. at Switcn Cutlets No. = 'Zas
F; F E . AL.-kpims No. at 'Zcnes
No. of Zetecnon ana
No. ar Ranges No. A,r ZZ -a— .__s
Ininating Cavicas
e a. 7a*a1
14o. -,t -::iscosais 0. P s
No. at Scuncing -::ev'Css
No. at c-eit ContaineC
N'a. I ScacetArea �ea:!n=
_'t Zisnwasners
Detec*:cniSouncing Oevices
* a. at Orvers i Heaunc =evlces
Munic:
-ccal 7-
Car-nec*:01"I
No. at
a%v Voltage
* 0. a t Water Healers Sicns Ba:ias's
winna
No. -ivcra Massace - u_ -S No. =4 Mc'crs -c-.a:
C-,
INSL�RANCZ :C'.tE=AGE. p._,rsuant -0 me recuirements z' Massacn"a=s ;enerai
I r1ave a ct;rrent Liaciiity Insurance Pcllc-/ inc.;_-:nq --r-.- tec C=e-a-cns --average or its sucstantial e uivalent. YES NO
;;# Y . �l a I Icate *.rie ry
Mave su=mjneo valto ;rcct of same tat t"18 Ctftcs. YES NC M318 cneclec ES - I re of coverage �-v
am;t��
znecxtng !n ! ac5F-riate lox.
'�CNC�
!v)
INSURANC_ Z OT -H -SR = tPle..a S=ec.: .
(Y
(F_xciration Oate)
'.
Es::mazeci Value c ecmcai 'Norx S
_ //
-Verx 1.0 Star, lns=ectcn C:a:a Pec;;es.ec:
=cugn
UC. NO.
NA.%IF-
'-;censee
4=_.vniet
Bus. 7el. No.
All. 7ei. No.
Accress Lai,,
CVVNER'S INSURANCE WAlVF_q: I am aware Mal -re L-:censetll Coe
rice suostannal ecuivalent as
lave :no insurance C--verage of its
n
.70
QuIrga ny MasSacnu3erM General Laws. ana Tiat MY s:%r-arure an
=ern�it aCPI'caticn waives inis recuirement. Owner Agent
aC8011"cautlon wativos Ir
tPlease cnecx one)
ooecncne No. PERMIT F=-=- 5
iSignature or Cwnte t -r Agenti
16E;�=
43
Date ......
2881
,toRT)l
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SAcmU
This certifies that .... ................ CU
has permission to perform ........ ....... ......................
wiring in the building of ... .........................................
North Andover, Mass.
at .... ��3.� ..... A 4. Z . ... .. ....
Fee ... .... .................. CTOR
f4 -
o
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File