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HomeMy WebLinkAboutMiscellaneous - 64 SUGARCANE LANE 4/30/2018 64 SUGARCANE LANE 210/106.A-0238-0000.0 j � I J Providing Insurance and Financial ServicesASA Home Office, Bloomington, IL Ed-te Farm April 26, 2015 North Andover Building Department State Farm Claims 1600 Osgood St PO Box 106110 North Andover MA 01845-1048 Atlanta GA 30348-6110 CERTIFIED MAIL: RETURN RECEIPT REQUESTED RE: Claim Number. 21-605K-338 Our Insured: Mark J Tina Date of Loss: February 18, 2015 Loss Location: 64 Sugarcane Ln, North Andover, MA 01845-3248 Tax Block: NA Tax Lot: NA To Whom It May Concern: State Farm Fire & Casualty Insurance Company writes to provide notice as required by Massachusetts law in connection with the matter referenced above. State Farm®received notice of loss or damage in excess of$1,000 at 64 Sugarcane Ln We hereby notify your office pursuant to General Laws c. 134, §36 that State Farm intends to make a payment of$1,000 or more in connection with the above referenced insurance claim. Further, the applicable amendatory Policy Endorsement informs the insured of the Massachusetts requirement by stating the following: "We are required by Massachusetts law that we must notify the local inspector of buildings or Board of Health at least 10 days before we make a payment of$1,000 or more for loss to a building or structure. We must also give notice if there is damage which makes a building a health or safety hazard or dangerous or unsafe for occupancy regardless of the amount of our payment. If, prior,to payment, we receive official notice of a pending or existing lien against your premises, we must delay payment until the matter is settled. If we are required to pay all or part of the amount of the lien, we will not be obligated to pay that amount to you. If you have questions or need assistance, please call (800)406-8543 and leave a voice mail message. We will return your call as soon as possible. Our centralized claim operation is also available to provide assistance. They can be reached at 877-783-1200. 21-605K-338 Page 2 April 26, 2015 Sincerely, Teresa J Bergh Independent Adjuster (800)406-8543 State Farm Fire and Casualty Company Date. (,u/.,.v.......... 10652 NORTH, TOWN OF NORTH ANDOVER. F p PERMIT FOR PLUMBING This certifies thatP , S.. ........................ has permission to perform.. t2,9 w o c- ................................................................................ ............. plumbing in the buildings of �ff ........ at..... .:l...... /`? .../.^:.:.................. North Andover, Mass. Fee./. . .....Lic. No.1....At HIV ................................................................... PLUMBING INSPECTOR Check# ! MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �. - CITY MA DATE -/ ( PERMIT# JOBSITE ADDRESS v R C����' L_ �{ OWNER'S NAME {�a POWNER ADDRESS TEL IFAX I } TYPE OR OCCU;ZOVATION: E COMMERCIAL 0 EDUCATIONAL DI RESIDENTIAL PRINT CLEARLY NEW: REPLACEMENT: Q PLANS SUBMITTED: YES 0 NO _ FIXTURES'l FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB __ I __( _._ I 1 i __.__.► I I _ _ I _.____._. CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ( -._,.�,.. DEDICATED GREASE SYSTEM _ __-J -_-I DEDICATED GRAY WATER SYSTEM ( . ( DEDICATED WATER RECYCLE SYSTEM f DISHWASHER _( f I ( ..___ _I I __-_j ! --.--j [ _._. —_4 -•.__I DRINKING FOUNTAIN FOOD DISPOSER t, _.1 ___.__. ...._._.._I __..._._( __.-___� ( _.____.) FLOOR/AREADRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY _-_.__.) _-_._- ( -_-----f _____J ROOF DRAINSHOWER STALL SERVICE/MOP SINK _ TOILET WASHING MACHINE CONNECTION _ 11 HEATER ALL TYPES i/VA E�PIPING OTHER 1fc 0 K h r- • ! I --( I -----� - --1 _( ! ----G - ---..1 t ._._..__r __ _f G 4 == INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES -. i NO _; IF YOU CHECKED YES,PLEASE INDICATE TH T YPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY _( BOND 0 `�" OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT In- SIGNATURE 0SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in�ompliance wi II Pnt provi ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ( PLUMBE 'S NAME LICENSE# 0 _ SIGNATURE MP JP Q CORPORATION QJ !1PARTNERSHIP P-1#�_�LLC Ey COMPANY NAME Y ; ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOOTES, Yes No lt�j( THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES OP Date.. ............... ....7/0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION HU This certifies that ... 5. Gs.e41................................:.............. has permission for gas installation Z w d W ... .............. ....... in the buildings ................. ...... at..(.... . ...... .........................: North Andover, Mass. ,Fee&Q....gLic. No./0266... 2�............. GASINSPECTOR Check At2q 9423N MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY Uri.�,� _ MA DATE PERMIT# I JOBSITE ADDRESS � !�N/-_ OWNER'S NAME r e X I OWNER ADDRESS A-L;C TEL —`� ;YAXL— TYPE OR PRINT OCCUPANC'TYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT:0 PLANS SUBMITTED: YES F--jj NO2/ APPLIANCES 7 FLOORS, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 ._ _._ .. ._._..�. Z:j L::J E ZZ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER . -a — . .. - FIREPLACE T1 L C-77-- FRYOLATOR { FURNACE GENERATOR _ GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER z { WATER HEATER OTHER ( { ........ .... - - — INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES JE]NO E] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYI OTHER TYPE INDEMNITY 0 BOND D P 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. i CHECK ONE ONLY: OWNER EI AGENT -01 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit Ill Pertinent provisioof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. a 1 PLUMBS ASFITTER NAME i LICENSE# ( SIGNATURE MP MGF E]1 JP ( JGF© LPGI[11 CORPORATION©#=PARTNERSHIP©#=LLC Of#= COMPANY NAME: _ �� f? �,� _„ ADDRESS �� C __ CITY STATE ZIP 3 67TEL — �— _ _ FAX CELL R EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES s s The Commonwealth of Massachusetts 02 Department oflndustrurlAccidents Office of Investigations 600 Washington Street Boston,MA.02111 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibl Name(Business/Organization/fndividual): Address: IJ Iff� - City/State/Zip: h ne#• 3 G Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am ployer with 4. El am a general contractor and I 6. F1 Now construction e oyees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]Elec al repairs or additions 3.El I am a homeowner'doing all work right of exemption per MGL 11. umbing repairs or additions myself.[No workers' comp. c. 152,§ (4 1 ,and we have no ) 12.❑Roofrepairs insurance required.]i employees.[No workers' D.-❑Other comp.insurance required.] Mny applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they 97re doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required-under Section 25A of MGL o.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. Aydoherelycerflyyunder t1 pat ntdpe Ities of 'ury that the information provided above is true and correct. - Simature: Date: C� C/ U i Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/I.,icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - Contact Person: Phone#: Information and Instruction's Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• express or implied,oral or written.,, An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be.an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 1 to yYour situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(ifnecessarY)and under"Job Site Ad ress"theapph' ant should write "all locations in-(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to he applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 ofMassaclivsPtts Department offAdustrlal Accidents Office ofInvestigatio.1,s 6.00 Washiugtou Street Boston,MA 02111 TO,#617-72.7-4900 ext 406 or 1-877-MASSAFF Revised 5-26-05 Fax#617-727-7749 ti• .J� ak COMMONWEALTH OF MASSACHUSETTS , o a o • o o ; . BOARD OF � PLUMBERS AND "GASFITTER' ISSUES THE FOLLOWING LICENSE L I CEN5EU;; AS AMASTERPLUMBER WI LLAM L DESANTI'$ r tii 1 P 0 BOX 1 r-, • <;Ei HAM NH 03076 000i p ... 10 768 05101116 221 40 nal lst- 3:1 -- i 7 F Date....... k..j.................... rj OF r►ORTF�,� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING �SS.gCNUS�S This certifies thati77,: ?� .... '�.... .. ........................................................ has penruss>on to perform tQl/. .�;,�:......-..�/../jet d.�� ................. wiring in the building of ... at .., '7..... ............. .... r. ................................, orth Andover,Mass. Fee./6...........Lic.No lo% .....r.::..:. .. �+ LE c RICAL INSPECTOR Check# i Commonwealth of Massachusetts Official Use Only NJ Permit No. IZ--'5� Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07j (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN)NK OR TYPE ALL INFORMATION) Date: 17/C/U City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) S'i n �,,y� (ya,n.r N, A/V&/Ctveot Owner or Tenant W IEt C k e','f' bd�f� Telephone No, 5173 0'4-109 Owner's Address A-5.4- S i £ 9 /e /c aoir aaip a 14,7. y,74.3-a st/srua J;rJi ja Ln 0 Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building .S F)Q Utility Authorization No. - Existing Service 000 Amps &0 19110 Volts Overhead ❑ Undgrd® No.of Meters � New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity 3 y1O Location and Nature of Proposed Electrical Work: /7R£/1 /Nv►svke / /)-V/0 Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 2,f No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets 36 No.of Oil Burners FIRE ALARMS No. of Zones No. of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained aa�� Totals: " " "" ..."".... Detection/Alerting Devices .i No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Key Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: /;z hiy Attach additional detail if desired,or as required by the Inspector of WYres. Estimated Value of Electrical Work: 33U0 (When required by municipal policy.) Work to Start: ?-/I--/q Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA-NCE ® BOND ❑ OTHER ❑ (Specify:) I certify,ander the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: (2A,9A1L° /yry Signature `� LIC.NO.: Q5 l/7 - a hcable,enter "exempt"in the license number line. 3 �f Pp � P ' ) Bus.Tel.No.: Address: Alt.Tel.No.: Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Licr'No.�, OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the ,. 1 permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass N Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ r Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: 1'UD S Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ IV Inspectors Comments: 7,Z Inspectors Signature: T— Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth ofltlassachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legribly Name(Business/Organization/Individual): 0L,1:,JrS f--(4Z Address: ,20 3 t?oies con o1 Ste' City/State/Zip: L 1'Iwa er ter 1 /'to 06LL3 Phone#: 9/ -2Fs� 9)_9 -9g35--- Are 9g33--Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.91 I am a sole proprietor or partner- listed on the attached sheet. 7. [�Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g• ❑Building addition 5 [No workers' comp.insurance 5. ❑ We are a corporation and its y 10.❑Electrical repairs or additions required.] officers have exercised the 3.❑ 1 am a homeowner doing all work right of exemption per MGL ILEI Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T"Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: [a q S vc Aix CAN N. OtO City/State/Zip: Adach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a foie up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby,certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: c&O.CL, Date: Phone#: 9?t 9 2Er 083 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: i, p �! Informati®n and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not producedacceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for:future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Coxxmonwealth of Mossa,chusetts Department ofhldustdal Accidents Office of Investigatiions 600 Washington Street i Boston,MA 02111 Tel.#617-727-4900 oxt 406 or 1-877:MASSAFE Revised 5-26-os Fay#617-722-7749 �e�pamnna uuecrl i� u Massachusetts -Department of Public Safety Office of Consumer Affairs&Business Regulation Board of Building Regulations and Standards OME IMPROVEMENT CONTRACTOR Construction Supervisor egistration 147062 Type: License: CS-058663 VExpiration:,.','-,��618/2015 Individual ` CHARLES A FAY A CHARLES A FAY JR` ' r 20 BERESFORD S1 s c Lawrence N1A 01943 - 4� CHARLES FAY 20 BERESF014D ST J,�... ,tl • >� �4� Expiration LAWRENCE,MA 01843 Undersecretary_` 05111/2014 b . Commissioner ��r f' ' 5 MO [`,7J iiv77 x r r ® 4M Etl 4 4 L y�'f+� i�y�t �y{3��g�� �£. d.l.: r1 Lt''�g/t,#7. M `"�` S .. R � a J a R (xyp `F 4i su 51 � + dlS� r y s t y yip Z . w yl 'i ,.� !:: ,.t "6�; '^�• - t �.,! � fig,�` r ',� '��� F.. f "t .�"§i*. "AWY T4 SGP .c? ANb 11' �i '. '. I>,1V.� Frrfu 31,gs .�...y�+'1'�.�r�\�L� ��, ���I' �I... ' , ,JY - �r µy 1 /`�.�` ,�. IIi�F�'� '21.?� • - SZ.S' i 'x i SP.�PT1� 'r��►� 13�,os ^'"•�rf�2 ,. 58.5' s1�5' - . .. -� , �d�T. � �H IZq F •: �! • i� • �oT 31 A E .14 �p,� Ga►I.iE LAu� Pt. SUBSURFACE DISPOSAL SYSTEM LOCATED IN dorTN Q tip 0\16 Q , t'I Q►, AS PREPARED FOR 619LOO &L, VI L.L AGUE PeW. CORP DATE : . ;MIV 71 I��S SCALE: I.'= MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 TEL (617) 473.3333, 37 sni Location ( 'oo6ALC.�tNE LAR 6t 31A No 5 � Date !' N°;T TOWN OF NORTH ANDOVER, b S Certificate of Occupancy $ Building/Frame Permit Fee $ ltA2- 'Ss�cNusEth Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector N" 7788"' Div. Public Works .sti .�;s{.J ,�`Y—` i+.+M+"`-'F"s.V"SF.� v...ti�"'4."✓'`�T _"'-,�'+�+'r.. m. .,{: r.t' f"w a•�'.7� Loction C91� 4(ZC� z k No Date N°"T" TOWN OF NORTH ANDOVER Certificate of Occupancy $ > ; ' Building/Frame Permit Fee $ E �'+ Foundation Permit Fee $ €a •L Other Permit Fee $ Sewer.Connection Fee $ R Water Connection Fee $ ' TOTAL $ Building Inspector `�s' 7789 Div. Public Works t Location .41 No. Date !In 3-9 t „aRTN "' TOWN OF NORTH ANDOVER Certificate of Occupancy $ 40;9a Building/Frame Permit Fee $ Foundation Permit Fee $ �,SSACHU`+ES Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ bU Buildinsitel,ns for t- 8 426 ' � Div. P c orks ' (.,� c5�t.tC� u��m►? 5lS"- 1Gat�eQ —t�l6a,�1 scl�Nl�$- �y,0 Wotica,� 'po3�1,� PERMIT NO. �./ � APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. p(�utp�� PAGE 1 MAP4,10. / I LOTNO. / 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE 20NE ,p Ito SUB DIV. LOT NO. ;LOC T O I� PURPOSE OF BUILDING OWNER'S NAME /jn�X� �O_ft, Veto NO. OF STORIES :rJ SIZE �C Am 1✓7G.� b OWNER'S Ari DRESS Q BASEMENT OR SLAB ,Q�,�` AJC P-14, ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST ,O 2ND y x! V 3RD Oma" BUILDER'S NAME ;��/` SPAN 1� DISTANCE TO NEAREST BUILDING �t,� DIMENSIONS OF SILLS DFSTANCE FROM STREETl7.S' / / "• POSTS DISTANCE FROM LOT LINES-GGSIDES 3 .3y REAR /d v GIRDERS AREA OF LOT `/a7 5� / FRONTAGE / 31d HEIGHT OF FOUNDATION �YQ / THICKNESS IS BUILDING NEW /� SIZE OF FOOTING o7-0 X IS BUILDING ADDITION 'G MATERIAL OF CHIMNEY /� ot10!;� IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER Xto BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER N� IS BUILDING CONNECTED TO NATURAL GAS LINE LD g INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST 'a i L D t7 SEE BOTH SIDES PERMIT FOR FOUNDATIOUbEST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 REGULATED BY PARA. 114.8-S."C. EST. BLDG. COST PER SQ. FT. �7d J � EST. BLDG. COST PER ROOM .2 PAGE 2 FILL OUT SECTIONS I - 12 r�'TJ��� //�� A SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDINDATE 1'7- FEE PAID _ISTO .-_ . 4 APPROVED BY T ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPEARMIT FOR FRAME/BUILDING DATE FILED l a7 /�7 DATE: 4 FEE PAID' toZ BUILDING INSPECTOR SIGNA RE OFIOWNER OR AUTHORIZE ENT F E E ' t•1Z ^ OWNER TEL.# PERMIT GRANTED V CONTR.TEL.# I2 19�� CONTR.LIC.# y :'� _ y 1.5Nmifl�lii.�! # ' LESS FDA FU ..a�.�� ' Dtoo I=G — 619911 ! DUE FRAME PERMIT$ 16Zct �'84Zb �'�Cj BUILDING RECORD i OCCUPANCY 12 I SINGLE FAMILY - S;ORIES THIS SECTION MUST SHOW_ EXACT-DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _. OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH 'PORCHES. GA- APARTMENTS RAGES. ETC. SUPER IMPOSED.'THIS REPLACES PLOT PLAN.- CONSTRUCTION 2 FOUNDATION $ INTERIOR FINISH CONCRETE � 3 I 2 CONCRETE BL K. PINE '' v BRICK OR STONE HARDW D _ PIERS PLASTER DRY WALL - UNFIN 3 BASEMENT AREA FULL FIN. B M T AREA _ FIN. ATTIC AREA NO B M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS - - CLAPBOARDS - B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D V ' ASBESTOS SIDING COM/,ACN VERT. SIDING ASPH. TILE ' STUCCO ON-MASONRY, _ STUCCO ON FRAME • _h'+ Xi It 17,11 BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME I I. • •t•i a•ra•Y •• >w;.�'A s CONC. OR CINDER BLK. STONE-ON MASONRY WIRING STONE ON FRAME _ SUPERIOR OOR • 1 tj - ADEQUATE I NONE '� d-• a�, 5-_ :RQOF _ :.,..' - 1 O PLUMBING GABLE `HIP "Z _BATH (3 FIX.) fI. ; `lj,l+"�`. =1 j► GAMB4El th1ANSARD 'TOILET RM. (2 FIX.) FLAT �.. _SNEQ WATER CLOSET ASPHALT:SHING.L`E$ -'-' LAVATORY WOOD SHINGES KITCHEN SINK 'F7 '• , SLATE NO PLUMBING -� - •� •• - -+^ - TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR = TILE DADO ' 6 FRAMING I 11 HEATING - WOOD JO15T' PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM " STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G ' UNIT HEATERS . '7 NO. OF ROOMS GAS T jL"Alin � OIL B'M'T2nd ELECTRIC 1st J 13rd I NO HEATING PEWMIT NO. -- 0 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PACE i MAP 4-40. /&16/,4 I LOT NO. .� j/ 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE — I ZONE D 7SUB DIV. LOT NO. LOCATION -� PURPOSE OF BUILDING j! 3zl OWNER'S NAME NO. OF STORIES -SIZE �''. y c r- OWNER'S ADDRESS BASEMENT OR SLAB f� S� ARCHITECT'S NAME - SIZE OF FLOOR TIMBEFfS ISTA 0 2ND I � 3RD aX�J „ BUILDER'S NAME a ogaot of 4t SPAN DISTANCE y0 NEAREST B IL LNG /�r / DIMENSION5770F SILLS --- DISTANCE FROM STREET �r / POSTS DISTANCE FROM LOT LINES-SIDES REAR ROZ6 U - GIRDERS • -12 1- AREA OF LOT 3 6r.y f ROF NTAGE S� HEIGHT OF FOUNDATION N4 THICKNESS IS BUILDING NEW h SIZE OF FOOTING b zo(J % IS BUILDING ADDITION MATERIAL OF CHIMNEY lit +G IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY J IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE P 5 ` INSTRUCTIONS m;°` 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES Z` EST. BLDG. COST ' ®�Q, t� l COST PER BQ BLDG. . FT. PAGE I FILL OUT SECTIONS 1 - 3 EST. PAGE 2 FILL OUT SECTIONS I - 12 EST. BLDG. COST PER ROOM T� SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY '7 '< ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ' DATE FILED / /_/7 , P c�--trr. � OUILDING INGPKCTOR SIGN TUR O. ER OT/HORIZ «-ti E�r^.,•-,,, F E E,. L OWNER TEL.11 PERMIT GRANTED •� r, _ CONTR.TEL.J/ " 19 94 CONTR.LIC.# %�!�z H.I.C.# s BUILDING RECORD 1 OCCUPANCY 12 A SINGLE FAMILY SoCRIES -THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM _ MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA— APARTMENTS - RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH , CONCRETE 3 1 2 3 CONCRETE BL K. PINE _ - .BRICKOR STONE HARDW D PIERS - —— ` PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT I ' AREA FULL FIN. B M T AREA '/, 1/1 '/� FIN. ATTIC AREA _ NO BMT - FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE ��_ WOOD SHINGLES EARTH ,J _ ASPHALT SIDING HARD",/'D ASBESTOS SIDING COMf.ACN _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY J_ STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE,ON MASONRY WIRING STONE ON FRAME _ SUPERIOROOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK \ , SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING I) 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS - OIL B'M'T 2nd ELECTRIC 1st 13 d NO HEATING z:R16a�yy... ORT{ Town of over 1V®. :`,�`�`' r 1 brt dover, Mass., LAKE 3 COCHICHE-ICK .S �p DRATE D PPS �C . V BOARD OF HEALTH Food/Kitchen t Septic System PERM IT T BUILDING INSPECTOR aRA� ��t3QIE QArnACL6,�A THIS CERTIFIES THAT........................................................................................................................................67:4 .............. Foundation has permission to erect-W400.....F".ME. buildings on ...59 4�M....(ANjE.......... B.1-4) Rough Chimne to be occupied as tl�l, l, ..�7�i111114.t��we��.l�.k�....... AJ�..?.4 �4.... 9ACV............................................. y provided that the person accepting this pl+rmit shall in every rect conform to the terms of the application on file in Final n By -Laws relating to the Inspection, Alteration and Construction of y this office, and to the provisions of the Codes and g p , Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR V VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough Final PERMIT EXPIRES IN 6 M04AT� IZ ��� FEE PAID UNLESS CONS '�( S sv �� ELECTRICAL INSPECTOR Rough -x B � ........................ Service .. ..... .. .. .... ............................................. . BUILDING INSPECTOR Final D �4 FEE PAI Occupan�T'ermit Required to Occupy Building GAS INSPECTOR D•s la n a Conspicuous Place on the Premises — Do Not Remove Rough P Y iP Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMITg4 ,� I ,..,. ..0 R1,I ToVM of �� li r` t 9 < v ®ver 0 "? No dower, Mass., 199 o LAKE4 1, COCHICHEWICK • w A \\ PP ^C� BOARD OF HEALTH ILD Food/Kitchen Septic System PERMIT T BUILDING INSPECTOR 'j?�tZ.Aq� *-beeeir. QArA�2��� THIS CERTIFIES THAT........................................................................................................................................0 .............. Foundation has permission to erect.. Q.....MAME. buildings on :. ... �v�A�k....(oWF........... f- .tom Rough to be occupied as 1 1:? .. k4.t We��.l�.�ea......�+11 .... .�.�.A..1Z....C?.QgAQ� ... Chimney thprovided that the person accepting this permit shall in every resect conform to the terms of the application on file in Final is 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. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough Final PERMIT EXPIRES IN 6 MOIAR1,; FEE PAID ELECTRICAL INSPECTOR UNLESS CONS `RI T=-AIA-0'.S Rough "al, ......................... Service BUILDING INSPECTOR Final I Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final • No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No, Smoke Det. ' SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT 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: Phone LOCATION: Assessor's Map NumberParcel ,7 Subdivision �uGiA..tzcq•-,✓ ZLot(s) / Street `)�� 44,✓,r__ St. Number _ ************************Official Use Only************************ REC NDATI S OF TOWN AGENTS: Date Approved C servat on Administrator Date Rejected w Comments Date Approved T'ow' n -Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved A0 Septic Inspector-Health Date Rejected Comments ;3P4_AG,-4 'PAbsiyc//MIQk-1Kj- I Public Works - sewer/water connections �� /zpO-�� ��+.��( f5)_i7- i - driveway permit -04V Fire Department Received by Building Inspector Date 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: _ / jJ� � Phone ��r, 5�-7,F7 I— LOCATION: Assessor' s Map Number Parcel Subdivision S_)m(L CAKIIE Lots) Street (4 St. Number �� ************************Official Use Only************************ RECOMMENDATIO OF TOWN AGENTS: A , �! Date Approved Co servati_ n Administrator Date Rejected f�v Comment i�;°.'I �1� %2 1 i - �'�% �. /2= L Date Approved Q Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments / n Public Works -._sewai water connections %_/_ /����1 c driveway pe it I ` / r Fire Department Received by Building Inspector Date NOV - 3 I9Q�" i 6 112.4+/ oz! o : �y 1 9LEGT2LG • 'GASEP'1�1.Fi r 75,62' �t�yg.32 �Q G�� E La►Jr' Gia � 'r ,4145;ecgY recr.,-- ro E 4olT� A,4 00VEA PLL O T gU14D6►.1A 0 ' rygT r.✓E N, /s taeorEo ov T//6 GOT AS S.fCi!-.v ANO T•caT?OAFS ro,s/�ae.,� /,V lY/T.�1 Ti�/E'(bW�J 0I'r Fes. ANLbVE�20N/.vG ,�E6!/LAT.�Lt�s �nta UrEo i�r�T.Ec�reo�,scudo i�•gzeco.o.PE�T O.PAN�it/ fO.P � Syawnr Div Ffi�+.?• G'an.i.yuviTy P.tvct "� 150oq� UDD`(G 1., 1,9-1 3 COLO 1�l I AL 1/I LLC�G�� �Ey'GI.c�ME r-IY OF M JE .P.L.S. GATE � % �j O • ,��..� . ?✓' , I G X17 HOFMANN y E 36381 W SUM a4- -� v \� � r,I I � u / --- 14 ' l 1 a. \ 't ��,1i�. .t�\` _r•`r^'. .��'Vl + �:( � 1 � � \. � Vit•: r ( � �• t �},,, v ..>;:r\�,. ,t�;t�!'a' _4c•\:'�. t•.•1: . ^t '�'". tf{.,, 1.*`,�tF,. 4.. .\.-v.�e..'.T(..;t.r.•:;fi.�'�:s,v:s{�t�.v>:1rR.'xi,m-.j.,r;l,;•.�a-`1.'.ti�,ra.,�t��rt},..1(ri 14'.`.•\zI\3r.�.'.i\`�,-s!�}:T7'Sy.iv.V\'..,retr1�_.,��-i.,..t:ti1tipv+j-.-:4�*�+��.\�.t�'i-'.z,-•;<.:�ak�.`•.\?+'a�i sr?seT.���;'',.!S-.�,1�i';li':�i;fi•f4 eCr,''1i":rRi.�rt1,fi:nt.t}•l�.—'.1:'''^.w�``r1:,':.-`1:Y`";.+\�•a x,.h.,l�,j.'�,`tr,,0�>.\4.a4.,.c1y�.f`SF\�.��;�9�S�r\sa\'\r-'4"F-1.,5�'iFS�,v;i11\+y-}i k-y�*.:t.�.,4ra±5..(',�,,'+i`�5e.1t�+�j�\'.t(E�ai\�.•:t�:fir.�.:•j,:.".�,'?\S.�1.•�z\5,`'�(Z15\•{�1-��1.'�•�-'h�'��r�3 t 2 i�'.-Je A', 't•{.t. s.•Rolla, Ei '1 !y;.�.'�.L'v;.:.'lo�lf`(1...�+}iti,.!'ltt�!Yaf��.,a+��'\,:�rc�.,.'�t`�,.d•��.'i�''\.s:wFr s,4�,�"1.rft�\,r•!,"'7..f�1��Ti�..t;t�o�`�\�I.�..�;_t,'�i.`:4-,1)':i..��;�w�l•U���.�<l'�tI�a'' j .,..{r. �.: , FT _ S - fie �omrrrreoazufe� o�✓f/�aaaac�ivaeltsrt ,, - »._ . �' Restricted To: 00 DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE 00 - None Number: Expires: Birthdate: IA - Masonry only CS 052241 10/10/1991 10/10/1952 16 - 18 2 Family Notes Restricted To: 00 WILLIAM K BARRETT IPQVM1=0N•R 111 FOREST ST " N ANDOVER, MA 01845 :may" Location No. CDate 2 2 ,.0R*h TOWN OF NORTH ANDOVER o�� ..e ,•�tioo Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ jdCMUSE s Other Permit Fee A $ 2S Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 2J r C�� 1 Building Inspector 02/20/95 09=44 MOO PAID T ' 7927 Div. Public Works KARIN HTAELSON Town Of 120 Nlain Street, 01845 Dirern'r _ NORTH ANDOVER (508) 6824483 BUILDING •`'Ss:' r``9 CONSERVATION DIVISION OF HE A TII PLN�I�c; PLANNING & COMMUNITY DEVELOPMENT P1.:1 CHIMNEY APPLICATION AND PERMIT DATE j9q PERMIT n LOCATION_ ✓u 6tA Cq Y) NER ' S NAME ' L. Op Y►1'e L O OW /tan ��--- BUILDER' S NAME I O y t eA Be 1/L' �^ tO MASON ' S NAME i C P1 C{ )I F I MASON ' S ADDRESS MASON ' S TELEPHONE 17 q 32- r-tY J MATERIAL OF CHIMNEY I14TERIOR CHIMNEY EXTERIOR CHIMNEY kA e 5 NUMBER AND SIZE OF FLUES THICKNESS OF HEARTH Will chimney or fireplace conform to requirements of the code and have rules` and regulations been received: DATE Z�ZL SIGI4hTURE OF MASON ,�� V) 1 l CONTR. LIC. EST . CONSTRUCTION COST/CONTRACT PRICE PER114T7 GRANTED z��c �� - FEE �ZJ RO fid, BU-ILDI14G INSPECTOR lam. IIISPECTED REll�"kRKS DEPARTMENT OF PUBLIC SAFETY SOLID BRICK REQUIRED CONSTRUCTION SUPERVISOR LICENSE Nuober: Expires: Birthdate MUST BE DISPLAYED ON THE PRE14ISES CS 053104 01/05/1998 01/05/1951 Restricted To: 00 JAMES C DIPANFILO 15 BENNETT STREET COMMISSIONER 8WOBURN, MA 01801 GNER r . n yR ,�� � 'i �d+`T. 5,�^` n- . '�! '.�:� � �(��.0 _ over 41 i a� Y�3;Y4 �t , o 'r3fi"�yi� sy+�•. k E � ��rt 4AC, dower'�`Mass-'O u ,. T N_ LAKE g:' ' �1 " Q cocHPCHewICK ��' �•r r t j g —O PP\ G) aij4�q � tti"fix RATED F '9 E BOARD OF HEALTH#ii`tiq W— Ol `Tr. i .i:. ? ,� s r, �''}.J•i = �t- 7 ,� �'='fix '`E. � •. 1� � '�,k. r r. j �. .; Food/Kitchen: { .air � .xa.r �s ' � �; g" if!�:E I�1 ���; rM�y� .tai 't, 1, '.� • "+s� -'a„; ,Ff�� 5 �' 7 ji.?.}.I����'+r - �t 4� 3 � '. �r �� ;5� �!.t* iiT�^191�.}.� �4,y: .» 4Yr t,.. ., ,,I� � p a ,. Septic System N4 ti k4 NAIyt, , p .a kyrr } ter li g� � > f BUILDING INSPECTOR cF TH15 RTIFI SWVVM ................................................ 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'•kt"4,:1 ,,.,.: '4`if .,i ,,. ,h,.. ,*t„r ,l a.t�. - Y �, t t s. 'fin. K,x ,s.s . €r€.�n-��i<,. -is.,,,4 AI ORT ToVM F Q of s - ' L over No. o <_ A LAKE dover, Mass., 199 CO HICHEWICK �• �d AERATED-PP�y.�S 7 BOARD OF HEALTH Food/Kitchen . PER .M ,IT T :. Septic System THIS CERTIFIES THAT . L Ra6W EZeIe 2,AM4tzQYA BUILDING INSPECTOR has permission to erect tc)Q .:.. 4:f?1fL,buildings on ...��6�de�cAx�, (pj„�-�F a F ound tion . .. .t ou 3 i a to be occupied as 2aM�V I-A.IYa! we��lt)k� C'A(Z 1........... 4mney provided thatthe person accepting thistl rmit shall in every res ect 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 inspection, Alteration and Construction of Final d, Buildings in the'Town of North Andover. . PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR 1 VIOLATION of the Zoning'or Building Regulations Voids this Permit. REGULM BY PARA. 114.8-S. B.C. W35 1-c� _ PER:1v1IT EXPIRES IN 6 MO I q4 FEE-PAIS { ` �� ELECTRICAL INS EC : UNLESS CONS IBJ z{ S ��C` ZRo ✓ no ff, R- MUBUJ � f 9 �� BUILDING INSPECTOR '" DA �- gM4T a FEE PAM .�,(62- Fi Occupancy 7rermit Required to Occupy Building GAS INSPECTOR y in a Conspicuous Place on the Premises -- Do Not Remove -f• °" Display 61_/ � '� F -No Lathing or Dry Wall To Be Done `n 0 a Until Inspected and Approved by the Building Inspector. DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street N SEWER WATER FINAL DRIVEWAY ENTRY PERMIT Smoke Det. 1