HomeMy WebLinkAboutMiscellaneous - 653 OSGOOD STREET 4/30/2018 653 OSGOOD STREET
210/100.0-0010-0000.0
Date.... .....
. .......
ii l
OF
&ORT
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4reo
mu
7This certifies tha ' f
.........................................................................................................................
has permission to perform .....
Ae
wiring/in the building of....... .j .0e...........
........ ........
at
................. North Andover,Mass.
Fee..6..................Lic.No.21..5 --�....................... 1. ...................... .. .. ..........
ECTRICAL INSPE
Check#
Print Form::
lMAE= ,orramontuealth o� a�fathu6e Official Use Only
d�/ eLJePartment o�}ire�ervice� Permit No. I �li�
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev-1/07] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Y 4�1
City or Town of: tVPAnt 4,rw'614;� 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) 6T5 as-r--nD-b $'�
Owner or Tenant g:�edi W IAJ Telephone No.
Owner's Address E
Is this permit in conjunction with a building permit? Yes ❑ No Q (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters 3
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
- -
Completion ofthefollowinggtable maybe waived by the Inspector of Wires.
No. of Recessed Luminaires 'J No.of Ceil:Susp.(Paddle)Fans No.of "Total
Transformers rKVA
No.of Luminaire Outlets ! No.of Hot Tubs Generators KVA
AboveIn- o.o Emergency Lighting
No.of Luminaires Swimming Pool grnd. ❑ rnd. ❑ Battery Units
No.of Receptacle Outlets 26? No.of Oil Burners FIRE ALARMS No.of Zones ^,
No.of Switches 17— No.of Gas Burners No.of Detection and
Initiating Devices 10 01-
No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices
Heat Pum Numb_er Tons KW No.of Self-Contained
No.of Waste Disposers ----- -
Totals � •�----�-•�-- Detection/Alerting,Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal 0 Other,
Connection
No.of Dryers Heating Appliances KW ecurity Systems:
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring: r+
Heaters Signs Ballasts No.of Devices or Equivalent .
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent 3
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of E1 ctrical Work: (When required by municipal policy.)
Work to Start:y l Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
' the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
' undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑,/ BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information otl:i ap on is true and complete.
FIRM NAME: DAVID ELECTRICAL CONTRACTING LLC ,� LIC.NO.:
Licensee: DAVID HAGGAR Signature t LIC.NO.:14963
(Ifapplieable,enter"exempt"in the license number line) Bus.Tel.No.:978-682-6262
Address: 87 BELMONT ST;NORTH ANDOVER,MA 01845 Alt.Tel.No.:978-375-5734
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.
.r
d 4
f
�f _
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
d� 600 Washington Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): i DAVID ELECTRICAL CONTRACTING LLC
Address: !
X87 BELMONT.ST
-
City/State/Zip: E NORTH ANDOVER MA.01845 phone#: 1978-682-6262
Are you an employer?Check the appropriate box: Type of project(required):
1. x. I am a employer with 84. El I am a general contractor and 1 6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2.3 1 am a sole proprietor or partner- listed on the attached sheet.# 7. Remodeling
ship and have no employees These sub-contractors have 8. E3 Demolition
working for me in any capacity. workers'comp.insurance. 9. IJ Building addition
[No workers'comp.insurance 5. El We are a corporation and its
required.] officers have exercised their 10.�Electrical repairs or additions
3.0 1 am a homeowner doing all work right of exemption per MGL I LID Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.[0 Roof repairs
insurance required.]t employees.[No workers'
comp.insurance required.] 13. Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContfactors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I ant,an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: I FEDERATED INSURANCE
9353694
Policy#or Self-ins.Lic.
iration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct.
Signature: Date:
Phone#. 978-682-6262 or 978-375-5734
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
COMMONWEALTH OF MgSSACHUSETTS
,Fs o o1p - o o
BOAf�IF�C��'
CTR I Cl AIiIS
fSSUES
THE„FOLLOWING LICENSE AS A
REGISTERfD MASTER ELEC,-W C,IAN I'.,.
..KRIS OPHER Di HA GGAR
631 RIVERSIDE 4VE Z
I APT 2;::i:::,
iJ
HAERHILL " MA '-01830-6
7
2155 °:? o7/Ilil 32655
Date. . . . .:. .lJ.....
NORTH
TOWN OF NORTH ANDOVER
' PERMIT FOR GAS INSTALLATION
l4 1 � •
�9SSACMUSEt h
This certifies that . ! �-:-�� l+4. �
has permission for gas installation . �°� . . . . . . . . . . . . . .
in the buildings : :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . �� . . .l a -�. . . , North Andover, Mass.
I: /
Fee.-�-� Lic. No.. n. .� - I- . J�'`�!�,. . . . . . . . . . . .
GAS INSPECTOR
Check# ��/,�
7188
MASSACHUSETTS UNIFORM APPUCATON FOR PERAHr TO DO GAS FrrrING
(Type or print) Date G
NORTH ANDOVER,MASSACHUSETTS
Building Locations 653 Osaood St- Permit#
Amount$
Owner's Name Charles Daher
New Renovation Replacement ❑ Plans Submitted ❑
a
o w F F¢ '� o Z c z w
o � w
w ar
a z c a� o w
WC7xW v�
rLE-4 z z >G z -i C OO z W
> q a F O
SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2 N D . F L O O R
3RD . F L O O R
4T 11 FLOOR
5 T H . F L O O R
6 T H . F L O O R
7 T H F L O O R
STH . FLOOR T—N!
(Print or type) Chec one: Certificate Installing Company
Name Andover -Plumbing & Heating Co. , Inc. VAorp 2122
Address 20 Aegean Dr. Knit #10
Partner.
Methuen Ma. 01844
BusinessTelephone 978 685-8383 Firm/Co.
Name of Licensed Plumber or Gas Fitter f;anrnP I a Rpse
INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked Les,please indicate the type coverage by checking the appropriate box.
Liability insurance policy f Other type of indemnity13 Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass.General Laws,and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 13 Agent13
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachus t State Gas Code and pter 14? f the General Laws.
BY: gnatur4f Licensed P umber Or Gas Fitter
Title Plumber 9983
City/Town 0 Gas Fitter ricense Number
ff Master
APPROVED(OFFICE USE ONLY) ® Journeyman
CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number427 Date— //Cz
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 1;9! S-3 OS Gyy ol St•
MAY BE OCCUPIED ASI e-_�, ., IV IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
o ;�,o CERTIFICATE ISSUED TO *f Ad u/a V
. 0p i
ADDRESS 6!6Q 0 S 4 0 0 cl
CNU' Building Inspector
t
�e`?,�` l;3 5.,',,, ,' ,. :.l[ •!+, IEi J a '.:y� 1 �t ��! —�Ab 3'1 F t�{� f, s h }y
' ..'... :� i ..:.1 `.� I �'• 13 T1' i {4' T Lt .+ f R I,,{� T� + i 1
..�ice. _f.._•f, ,i. r ���_'.o�F,?; t ,a�di�r1t,o'li_:,
N I:;
�TSFY
of
t eT® � . Andover
dover, Mass., iqxr
S I_AKE
9A_COGMICXEWIGK Y�•
.9 �gvTEp
S BOARD OF HEALTH
Pk� KMIT T
Food/Kitchen
Septic System
THIS CERTIFIES THAT.......41...:*#y.........#'.t.. 0..vj Q.�................ .. BUILDING
FoundationUI DING INSPECTOR
has permission to erect... �.......1111M4e buildings on .....&.573......... O.s.,y.104...s�` �/fn
................... Rough .�"� '1
to be occupied.as.....,� j X11.. I�......... .1..�. .................................. , .. . . ...�jj4AS...�........................ Chimney
provided that the person acceing this permit shall very respect conform"'to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating,to the Inspection, Afteration,and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit.
PERMIT FOR FRAME/BUILDING Rough
� 19Y
PERMIT EXPIRES IN 6 MON�,-IS FEE PAID: ELECTRICAL PE
UNLESS CONSTRU N TARTS LDINou
B G INSPECTOR
Fin
Occupancy Permit Required to Occupy Building AS/INSPECTOR
Rough R,T)
Display in a Conspicuous Place on the Premises — Do Not-Remove Final d
No Lathing or Dry Wall To Be Done FIRE DEP ENT
Until Inspected and Approved by the Building Inspector.
Burner
Street No.
R-ec 0- %a Smoke D
Town o t - a Andover Al
so
No. Ala 7
* -
z Ob dover, Mass., '19W
0 LAKE
4- -HICH ICK
II
TIED
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.........#10 ........... ..WN.Ay ........................
........0.Y - ................................................
Foundation'
has permission to erect....Paj.......199*11! buildings on .....&..S73..........05,�4)04...St................. Rough
to be occupied as......SCIA-sh.........Fl;km.t*' ............. ...;00*S...) ...**"*'****" Chimney
ili * o the ter un file in
provided that the person acce Ing this permit shall zovery respect conform Final
this office, and to the provisions of the Codes and By-Laws relating,.to the Insp n, Alteration and Constructio
Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY LUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED By PARA, 114. B.C. Rough'
Final
PERMIT EXPIRES IN 6 MON FM PAI
ME PAI EC-MICAL INSPECTOR
UNLESS CONSTRUCT4,0N TARTS Rough
.... .. ........... .... .......... ... ...... .... Service
B LDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
No L[Mthi`ngo`MDry%a`MITo Ve one Final FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
Street No.
R-e c 0- %6 %4-7 Smoke Det.
FROM : FLINTLOCK, INC, PHONE NO. 19786834436 Oct. 15 1998 10:43AM P2
1p is
i++
tab•aoa'� --
ly Y` r
I 149,14'
3718 15.i.
1.0 At.
124.4'.
39.e�
-+— $0,41
CXISTINa F13UNDATION
TLP FND EI.EV.iiuv
P.
N
� 5L0' --•- A
t
J
-�y ILITYi
EAS€MENT
t
N2a'1l'32"W 78,38' tx0aMt
to
92.48'
N3i'2v'47 W oSGOoD S""r.ES4Q1(;
.�-
No. 36049
1 v
'NC IsCRCOY CCI*T1F"t 714AT WC FIAYC AM114CD (vlfr19�
TmE PREMISES AND THAT ALL APPARENT
EASCMEN73 AND £NCROACHMCNTS ARE LOCATED
TP113 PLAID IS iNTENRED FOR ZONING AS SHOWNS PEPAREO . THE fiTRUC7URE 51141M1TJ JCtIF�It:
LAWS OF THE
FAOW, E)dS7PURPOSES IG PLANS LY, IT AANDPRECORDS �CN CONSTTHEIRUCTED, AL$O. ACCORDING MUMCPALITY TO THE
MTM TKE 97RUCTURES SHOWN LOCATED F.r-M.A./H.U.O, FLOOD INSURANC't RATE MAP,
SY AN INFRUMENT SURVEY, THIS PLSHOVL.0 NOT 2e USED FCR PROPERTYN DATED 6/2/33,COMMNITY4 THE SRUCTURE,g NOT LbGAW
LINE DETERMINATION. IN AN %glf M41% IAA vo ri rvtn UAT-DA sn..r
Growth Management Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
IN me of Applicant on Building Permit(below) Address of Property for Permit(below)
Map and arcel : P rpose of�rpplication (check below)
Ph Num pplicant: �/ Single Family _Two Family
I the undersigned pplicant for the above property attest that the attached building permit for which this
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party to this permit
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit ig issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a building permit for the enlargement, restoration,or reconstruction of a dwelling in
existence as of the effective date of this by-law, provided that no additional residential unit is created.
The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning ,
Bylaw.
This application is for dwelling units for low and/or moderate income families or individuals,where all of the `
conditions of 8.7.6.oare met and/or represents Dwelling units for senior residents,where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section"senior"shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40%permanent
reduction in density, (buildable lots), below the density,(buildable lots), permitted under zoning and feasible given the
environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently
designated as open space and/or farmland.The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism
approved by the Planning Board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and
commissions have been received and the project is in compliance with those permits),and the Development Schedule
does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per
Development until such time as the Development Schedule accommodates issuing building permits. Applicant must
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination'
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building permit is
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply,whether done to my
knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit.
_ r
ig ture 6`fOwner or Authorize gent who gned the Attached Building Permit Da
ThV form must be attached to the BuildiA Permit upon application for such permit
Town of dover
0
No.
Val
over, Mass., zo 19W
0 - COCHILH
CHEW" ICK
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.......G0- 0Y......... .. / ....vj.q...y......................................................................... Foundation
has permission to erect....tJtj.......tUfft buildings on .....&..r3..........0.3
1W st................. Rough
to be occupied as......SCA.4JI,.........Fftm.tk .......... S...)....................... Chimney
provided that the person accepting this permit shall ili every respect conform o the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relatingtothe Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT FOR FRAME/BUILDING Rough
Final
PERMIT EXPIRES IN 6 MONT V: 3—FEE PAID- ELECTRICAL INSPECTOR
UNLESS CONSTRUC>N TARTS ,, Rough
...................... ... . . ... .... Service
IKd INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
b. No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
Street No.
R-e c 0- V6 %4-7 Smoke Det.
� ,Location �
b (�c�: !� Date 7 9
i
N.
a 14pR7" TOWN OF NORTH-ANDOVER
E ` pCertificate of Occupancy $ SA g
. ;��> Building/Frame Permit Fee $ � y
g C14USEt Foundation Permit Fee �$
Other Permit Fee
$ .;
�j Sewer Connection Fee $ /000.4
3
` Z Water Connection Fee $
` ®aLL-41
TOTAL *' $ t .
1e o
:
-�-_. middies nspecTor�
tt� r8 t : �*I ,iBd).40 1gRI�f
`. � . 6.t Div. PuWorks
}
S
NO., - 4,A-7 Date 717-Z/':--0-
°"T" TOWN OF NORTH ANDOVER
p Certificate of Occupancy $ a
Building/Frame Permit Fee $
SSACMUSE Foundation Permit Fee 4
Other Permit Fee $
f f Sewer Connection Fee $ f ..
Water Connection Fee $
TOTAL $ Vol j ;
o
BuRdii tnspec )r-I ' , $
Ii1f�.tl"
2,180-00 PAID
�+�
Div. %6V Works
PEa'ltrr NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
——�& L—U-1
'%-----MAP K40. �D olu I L -N6---- 2 RECORD OF OWNERSHIP ;DATE (BOOK ;PAGE —
ZONE SUB DIV. LOT NO. �� ti` :./ I
ow
LOCATION /� .,� f , PURPOSE OF BUILDING
(_ Ila
OWNER'S NAME - ! NO. OF STORIES SIZE
OWNER'S ADDRESSI 'IASEME R SLABZ 44 �c
r
im
ARCHITECT'S NAME _ ` SIZE OF FLOOR TIMBERS 1ST ^ /C) 2ND"/ 3RD i®
BUILDER'S NAME .SPAN /{f /� -
DISTANCE TO NEAREST BUI DING /®®• DIMENSIONS OF SILLS
DISTANCE FROM STREET Jol POSTS
DISTANCE FROM LOT LINES–SIDES REAR
� GIRDERS
AREA OF LOT FRONTAGE v—T HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X .41
IS BUILDING ADDITION yCC�r MATERIAL OF CHIMNEY &;
IS.BUILDING ALTERATION IS BUILDING ONe–L1916R FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ✓ice i7 IS BUILDING CONNECTED TO TOWN WATER tl;o"c_s
BOARD OF APPEALS ACTION. IF ANY 7c,�) IS BUILDING CONNECTED TO TOWN SEWER f4e& q
IS BUILDING CONNECTED TO NATURAL GAS LINE -
INSTRUCTIONS �? 3 PROP RTY INFORMATION
LAND COST
SEE BOTH SIDES J` EST. BLDG. COST 9�L��' ��
EST. BLDG. COST PER SQ.
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC M EPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTAC D ARAGES MUST CONFO TO STATE FIRE REGULATIONS
PLAN ST BE ED AND AP O ED BY BUILDING INSPECTOR
A E F
BUILDING INiP[CTOII
\AIGN6MRE OF O NE IZED T
F E E 7 �t2v OWNER TEL.#
PERMIT GRANTED CONTR.TEL.N
19 CONTR.LIC.#
�3 S��=r-
H.I.C.#
�� �/" 7
BUILDING RECORD
1 OCCUPANCY, 12
SINGLE FAMILY STORIES 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 _ 8 INTERIOR FINISH SG,
CONCRETE d 1 2 I3
CONCRETE BL K. PINE
BRICK OR STONE H —
I-PIT
PIERS PLASTER
_ DRY WALL _
UNFIN.
3 BASEMENT
AREA FULL FIN. B M AREA
1/1 '/ 3/ FIN. ATTIC AREA
NO B M T FIRE PLACES t
HEAD ROOM MODERN KITCHEN
4 WALLS L 9 FLOORS v
CLAPBOARDS 8 t 2 3
DROP SIDING CONCRETE
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDV✓'D _
ASBESTOS SIDING COMMON ✓ _
VERT. SIDING ASPH. TILE
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME
SUPERIOR
ADEQI� NONE
UATE
5 ROOF 10 PLUMBING
GABLE I P BATH (3 FIX.)
GAMBREL MANSARD TOILET RM. 12 FIX.)
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY _
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER
ROLL ROOFING MODERN FIXTURES
TILE FLOOR !/
TILE DADO
6 FRAMING 11 HEATING I
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 V 2nd ELECTRIC
1st 13rd NO HEATING
i
PERMIT NO.-----I� APPLICATION FOR PERMITTO BUILD -NORTH ANDOVER, MASS. PAGE 1
MAP 4J0. 6 LOT NO. � 2 RECORD OF OWNERSHIP jDATE BOOK PAGE
ZONE —I SUB DIV. LOT NO. - I f. l
' LOCATION - _ PURPOSE OF BUILDING
OWNER'S NAME �, A NO. OF STORIES SIZE
OWNER'S ADDRESS /" ,• � EMENT R SLAB -
ARCHITECT'S NAME / SIZE OF FLOOR TIMBERS IST + 2ND _.Q/y�%%i 3RD
BUILDER'S NAME SPAN - f7"`(L✓
DISTANCE TO NEAREST BU DING �jy� DIMENSIONS OF SILLS --_
DISTANCE FROM STREETL�.f.. POSTS
DISTANCE FROM LOT LINES-SIDES 1 REAR Q�- " " GIRDERS '
AREA OF LOT T FRONTAGE .y'- HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW-/' ;./ P SIZE OF FOOTING + X f C1
IS BUILDING ADDITION MATERIAL OF CHIM
IS BUILDING ALTERATION IS BUILDING ON(SOLID R FILLED LAND ,
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE . -,J IS BUILDING CONNECTED TO TOWN WATER
s
BOARD OF APPEALS ACTION. IF ANY J IS BUILDING CONNECTED TO TOWN SEWER (.
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFOR TION
LAND COST fc)o
SEE BOTH SIDES
EST. BLDG. COST
FT.COST PER SQ
BLDG. .
PAGE 1 FILL OUT SECTIONS 1 - 3 EST. �ze-)
a
EST. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS 1 - 12
SEPTIC PERMIT NO. /�f[i 'LJGJ
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
WILDING INSP[CTOR
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E OWNER TEL.#
PERMIT GRANTED CONTR.TEL.a
i 19 CONTR.LIC.# ;7
H.I.C.#
BUILDING RECORD '
1 ` OCCUPANCY 12
SINGLE FAMILY STORIES 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 8 INTERIOR FINISH So 1p__'
CONCRETE
CONCRETE BL K. PINE
BRICK OR STONE HA _—
PIERS PLASTERSTER 7ze l!Zo
_ DRY WALL _
UNFIN.
1
3 BASEMENT
AREA FULL FIN. B'M'TAREA _
v, 1/1 l/, FIN. ATTIC AREA t \
N_O B M T FIRE PLACES _
HEAD ROOM _ MODERN KITCHEN _
4 WALLS 11-9 FLOORS '
CLAPBOARDS B 1 2 3 +
DROP SIDING CONCRETE �_ it
j WOOD SHINGLES EARTH
ASPHALT SIDING HARDVJ'D _
ASBESTOS SIDING COMMCN
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. 6 FLOOR -
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME
SUPERIOR IV ' POOR
' ADEQUATE I NONE
5 ROOF 10 PLUMBING -
GABLE HIP BATH (3 FIX.)
GAMBREL MANSARD TOILET RM. (2 FIX.) {
FLAT SHED WATER CLOSET I
ASPHALT SHINGLES jX LAVATORY _
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING I�
TAR 8 GRAVEL STALL SHOWER
ROLL ROOFING MODERN FIXTURES `
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING n
WOOD JOIST", PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 N OF ROOMS GAS
OI l
B'M'T 2nd ELECTRIC
1st 13rd NO HEATING
FORM U - IAT RELEASE FORK
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: &004 a�P ` au'y�� //D rs Phone �se
LOCATION: Assessor' s Map Number Parcel �� � -3
- 7
Suba, vision c®® S7Lot(s)
Street � 3 $04 S 7 - St. Nu.-=er
Use On1y************4***********
NDATIONS OF TOWN AGENTS:
Date Approved 01-
C:,nseY-:azion Ad-inistrazcr Daze Rejected
Date Approved 4�
Town Planner Date Rejected
Conr.,ert_=
Daze Approved
Fco:: _nspecz„_- ealth Daze Re;ectad
Date Approved /
Sept=c ros=e - ea_t Date Re;ecze_
Co-r.en.._
Wcr,:s - sewer/water connections —
- dr ivewav i0ermit Z �l
Fire Dezar--kent
ZReceived by Building Inspector Daze
TOWN OF NORTH ANDOVER, MASSACHUSETTS
DIVISION OF PUBLIC WORKS
384 OSGOOD STREET, 01845
J.WILLIAM HMURCIAK., P.E. Telephone(978)685-0950
DIRECTOR Fax(978)688-9573
AORTiy
10
2 y 6 Q
3 OL
O 0 m
n = a
u �
ISSAC EHUS
ES.
DRIVEWAY PERMIT
DATE f ��
LOCATION
BUILDER phone
OWNER 0,:qkv1'ecj cooq// �09 phone
THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS
MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM
STREET . CALL THE SUPERINTENDENT'S OFFICE BEFORE
FINISH GRADING AND SURFACING FOR APPROVAL OF
SUCH ENTRY.
FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT.
�JOR
Town
T
of #� _ e over
_ �
O L
No. a 'Zi&- -
* ` dover, Mass., 0 19W
O Z LAKE
9-�COCHICHEW ICK tiY 1'
q- V
'9S �q,4 T E p APf'`
BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
69.-Oey
BUILDING INSPECTOR
THISCERTIFIES THAT....... ......... . .. ... Q ......................................................................... Foundation
has permission to erect...�).......t&Mf buildings on.....&.$73..........O.S. ...S ................. Rough
to be occupied as.....+�l vi.. i�l.....:...ri. .A. .................................. .. . ...��4.0S............................. Chimney
provided that the person acce�ing this permit shall A very respect conform'to the ter n file in Final
this office, and to the provisions of the Codes and By-Laws relating_to the Ins p n, Alteration and Constructlo
Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLy LUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED By PAK 114.8-S, B4O. Rough
Final
PERMIT EXPIRES IN 6 MON T FEE PAID ,EfECTRICAL INSPECTOR
UNLESS CONSTRUCT4QN TARTS Rough
...................... ... . .... .. ........... ..... .......... . ... ...... .... Service
B LDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Vo
Final
�Lath=ngor Dry Wall To Be one FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
Street No.
�-cc , � Smoke Det.
NO 822
APPLICATION FOR WATER SERVICE CONNECTION
North Andover, Mass. 3 19
Application by the undersigned is hereby made to connect with the town water main in Street,
subject to the rules and regulations of the Division of Public Works
The premises are known as No. Street
or subdivision lot no.
Ido. AIJ-
Owner Address
Contractor Address
Applica is Signa ure
ko Z�
00
PERMIT TO CONNECT WITH WATER MAIN
The Board of Public Works hereby grants permission to ® cl t�(.J �V i1,'
to make a connection with the water main at Street
subject to the rules and regulations of the Division of Public Works.
C/f/ and of Pull' Works
B
Y
Inspected by
Date
See back for rules and regulations
F '
RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES
1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town
of North Andover without a valid permit from the Division of Public Works.
2. All water services shall be installed a minimum of five feet below the finish grade.
3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964.
4. Service connections shall be 1" type k copper tubing.
5. All fittings shall be brass flange type Mueller or equal
H 15202 Corporations
H 15212 Curb stops
H 15402 Three part unions
H 8185 stop and waste valves
6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4�/z foot rod and brass plug
type cover.
r
N® 1315
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. 23 19 ?t3
Application by the undersigned is hereby made to connect with the town sewer main in Street,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. ZStreet
or subdivision lot no.
kL
Owner Address
Contractor Address �—
Applic nt's Signature
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to �� j
to make a connection with the sewer main at Street
subject to the rules and regulations of the Division of Public Works..
Division of Public Works
By
Inspected by
Date
See back for rules and regulations
lt'02< /4t 4
J
�J T
F +
RULES AND REGULATIONS FOR;GOVERNING 'THE'INSTALLATION OF SEWER SERVICES
1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer
o`r appurtenance the'reof'without first obtaining a written permit from the Division of Public Works.
2. All costs and expense incident to the installation and connections of the building sewer- shall be borne by the owner. The
owner shall indemnify the (town) from any loss or damage that may directly,or indirectly be.,occasioned by the installation
of the building sewer.
3. A separate and independent building sewer shall be provided for every building; except where one building stands at the
rear..of another on an interior lot and no private sewer is available or can be constructed to the rear building,,through an
adjoining alley, court, yard, or driveway, the building sewer from the front building may be extended to the rear building
and the whole,considered as one building sewer.
4. Old building sewers may be used.in connection with new buildings only when they are found, on examination and test by
the (Superintendent), to meet all requirements of this ordinance.
5. The size, slope1alignment, materials'of construction of a building sewer, and the methods to be used in excavating,
placing of the pipe,`jointin"- testing;and backfilling the trench, shall all conform to the following requirements. The sewer
shall be 6"diameter SDR 35, PVC pipe.,Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four
feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a
minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown
of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of
the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift.
` 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all
buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such
building drain shall be lifted by an approved means and discharged to the building sewer.
7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or
ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer.
8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for
-inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superintendent)
or his representative. r " ' .j '• ` ' I
9. All excavations`for building sewer installation shall -be adequately guarded with,barricades and lights so•as to protect the
public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be
restored in a manner satisfactory to the (town).
9%Ze &mmowmleaa 165896
DEPARTMENT OF PUBLIC SAFETY 165896
ONE ASHBURTON PLACE, RM 1301
BOSTtlf+ '—MA 02108-1618
CONSTRUCTION SUPERVISOR LICENSE "
Number: Expires: �B--Prthd`ate`
CS 008587 OA/03/2000
Restricted To: 00 7-77
GARY A KELLOWAY QR
136 CASTLEMERE PLACE
NORHT ANDOVER, MA 018A5 [ �a
M Keep top for receipt and change
of address notification.
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S66028'41 JOW
N/E GEORGE W. & DONNA M. OUSLER
2991
Date -a"�!` . . .....
A g
I
tyORTH TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSYALLATIO&
p
ru
SACHUSES
I �
This certifies that . .�`Z. . . . . . . . . . ..
has permission for gas installation .A/��Via: . /-'A", . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . .
at S . . . �/s./. . . . . . . . . . . . . ., North Andover, Mass.
Fee.7� .—. . . Lic. No: .0? . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
"'MAS S,�G>EiUS;E'TTS UNIFORM APPLICATION FOR, PERMIT TO DG GAS��'�'Irl
}.
(Print oe Type)
NORTH ANDOVER. . Mass. Date
a.
asmttf nq Location ', 5 3�S��y� Permit 9
Owners arae
Reno atitan F�epiacement -Plans SU itted
FIX .
,•
a7 x
UA d C O
ca tLd W W O ff9 d LOC W
[�
tu CU A.a O ? U_ h W ..t Uj
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tat r Q G d q O Q [tt O UA 4
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�ASE i�tEt�B�' 4
4' !tT Fi.oam:
t� zriti t=soot;
�t a -
�i f1 F,L0(3 R }
S�t4 irLooi�
(�LooR
rM
(Print or Type) Check one:' Certit`'lcate;
ns-ailing Company Name ��� Q Cor#
'Address �t �^ s'�— Partner.
Firm/C o. .,.
ti
� -
Business Telephone: 33`� �c '7
Name of Licensed Plumber or Gas Fitter ��—
lnsUrant. Coverage: Indicate t!^e type o; insurance coverage by checking tFte s�
appropriate box:
•..
L tal. ility insurance policy Other type o, indemnity Bond
•.. ; b.P Insurance Waiver:, I , the uncersicneQ, have been made aware that the I:cense
this application does not have any one or the above three insurance coverages.
Signature of dwner/agent of property Owner Agent
It
I hese5y certify that sti of the dcUas s�vd information I have submitted (ar entered)in ebove application are true and accurate W thY best of mp �
t} ****hedge and arae W ptumbLig*Mork snd.lniwttations_;^erEarncC under Permit ixtccd lo.- this sprUcxtion will be in easmpLienan*Iih'ta Lt+tritaesst 7a�
itaiitsaeiiu'oc t4sa h4t[rar�iiwetes Billie Cas Cade za4 copies J4"of tao Genesat I.Awa.
TY LICZNS
B1, a
Plumber
=�
Title + - d uszstter Signature olr :��o rise
z xs NQaS ver pig Ga �.ter
C e t y/Tcjt rn
„ . journeyman
(ofFptcz_ use ot4LY1 License Number
.q_
;. �,1,,�;�,w� e,,., .. ,.,.;---,�...,.�u_'�-h/Aa+-.Exitu'ti-ti•�a:-r�.r'�:�����E�ws*..ia'+�.;�3'i'.n.�`*�l
Date
IT- 3865 /
g
M
HORT; a TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
SSACMUS� p�
This certifies that . . . . . . . . . . . . . . ...
has permission to perform c. . . . . . . . . . . . .
plumbing in the buildings of .1(e-z, rjb�4,Tx. . . . . . . . . . . . . . . . . . .
at. .5. . . S4 p. . . . . . . . . . . . . . . . . . . . .. North Andover, Mass.
iF3f . .
. . . . . . . . . . . . . . .7. . . . . . c.
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
*W CtiUSi~TTS UMFOnIM APPLICATIOM-F011 1PEt$6'VEZC -TO.€ O l El. ilttE3tt s ,.
00 Print)
x
WORTH ANDOVER ,Mass- ®ate:
�i
t � ui)di€ g Location Pernik
„
®w .
ners Name .
� 44ew Renovation Replacement Ej Plans Submi ted
Fi T[JRE
, •
CO
A A y
/o/ff�, z Z us to
ta
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o E- eta °g H €z.' as x at t» U. 7--
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c �a t=s sa to ae = a- cn w a aG — tr to O
stl �aSM
L UA amu ,
fit.y_ u _
V'
Tft FLOOR
# aT
'y (print or Type) Check one:,, Certtli�ate �
#rtstalling Company Name5,�p,i,�s� [� Corp.
. �ttd' ess S?'� .-, S l Partner.
�! Firm
Co.,
Sf; l7iQ
'pG 4 A�Tayn.
°. Buss.tess Telephone
,t lame' of Licensed Plumber:
x' 6tis€xrance Coverage: Indicate the type of insurance coverage by checking the a ;
sp"t-opriate box'
Bonda Y,
' � •;.'�i�(billty
insurance: policy � Other type of indemnity
r tn$Urance Waiver: ; i , the e a
.ne
undersi dhave been made aware that the licensee �f
g
`"'_thy application does not have any one of the above three insurancecoverages
h q.
r
S(gtiature of owner/agent of property Owner Agent + '
iteicby fceitiry tit mit of t!te:is Ili and infornoation((rave w6miticd (or entered)iu shove applivtion are true And izcirratc to Ute bes( an
'c3E y
Etkes fic<f c an alai alt piucttbing work and inttitlstions(.crfnrrued under r'ernrit issued for this at+plication wits be in coneptianee wilt all pcitilien 'No%
trt 0ftii of the Mittdwietti state riumbinr Cock Ind C7c2ptcr 142 of Utc Ctnetai Laws.
3..
Signature of Licensed P umber �s
iv e of Piumbin License r
C y/Town
_ g��
t r - ise Number e ' hast tar ® Jourzicytnan
IOV ED Zorr-icc USE o((t_Y) .a..,cr
N2 2 i 60 Date.
.... . .... . ............
NORTH
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4L
�SS�CHusf
This certifies that .......................................... . ........................
.............. ...........
has permission to perform ..... .. ........ .... ..........................
wiring in the building of.... .... ......... ........................ .... ...... ..........
at k 16
............... .............. .North dover,Mass.
FedLic.No - .... ...............................................................
ELECTRICAL INSPECTOR
12/10/98 13:36 375-00 PAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
ThF09Mt10NWE4LTH0FA14MCHUSE77S / Office Use only only
DEPARTAfENTOFPUBLICSAFETY Permit No. 6
BOARD OFMEPREVEMONREGM770AS527CMR 200
� Occupancy&Fees Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
a
The undersigned app1�i' a permit to perform the electrical work described below.
Location(Street_&Number) (27c
Owner or.Tenant /L
Owner'a Address
Is this permit in conjunction with a building permit: Yes o (Check Appropriate Box)
Purpose of Building &e,� � tr�
Utility Authorization No. �aZ7
Existing Service ---" S Overhead n Under-round
New Service Amps/,Zc, /.)t/c/ Volts Overhead r-7 Underground '- No.of Meters /
Number of Feeders and Ampacity
i
LScation and Nature of Proposed Electrical Work
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total
I KVA
0 of Lighting Fixtures Swimming Pool Above Below Generators KVA
round EJ ground
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No of Disposals No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
No of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sound ing Devices
No.of Dryers Heating Devices KW Local J7 Municipal Other
Connections
No or Water Heaters KW No.of No.of
Signs Bailasis
No,Hydro Massage Tubs No.of Motors Total HP
OTHER
(rmr-arce Caa-age Ptasuatlt m the tegwrarrais �Galeal Laws �._
I have a art3rt Liabtldy hstxare Pohcy trrhxlrrg Cariplese aati or sub�tiial tualat YES ® NO ED
I hawsubmn> dvalid poofofsameotheOfoe YES NO rI lfjcubmtdtad(edYES,pleaseirdi&thetypeofwaaWbyt�tgthe
apvwlaebac
INSURANCE r7 BOND F-1 OTHER ftl3sespedfy)
Expiration Dr�e
EsmnawdvaluealElectrical Work$
Wak to Sart "Q/�5 lrspection D*Redd Rough Fsial
Sigted t deal e Pavilties of T
FIRM NAME _/W/&A/4-C L i� �v v9-rk�c- '�Ce c�irfl= Lioa�seNa Ll-?CJ U
Bukxss Tel.Na
Adm `^ (?U+ �t ��' �� —l L �- AIL Tel.No.
OWNER'S INSURANCE WAIVER;I am aware that tie does not have the anlraneaot Boras akW#tial etxalentais nomad byi tsodssefts Genual Laws
and du my sagrataern this pemffi apphcmm wars this M#Unent.
(Please check one)- Owner Agent 17
Telephone No. PERMIT FEE$
f
t
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� \� t
3
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1
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t
Date. . !. . .G. .�.. . . . . . . .
Of NORTH
02 TOWN OF NORTH ANDOVER
F p
' PERMIT FOR GAS INSTALLATION
SACNUSE� `
'i
This certifies that . . . .?. `. :'. . . . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . .�. :ly//.!j^. . . . . . . . . . . . . .
in the buildings of . . �� . . �'.�`. . . . . C°. l��. . . . . . . . . . . . . . . . .
at . . : �. <? .s. .�.. . . . . . . . . . . . ;North Andover, Mass.
Fee.1. ?: . . . . Lic. No.. .0 .3;t . . . . . . .
GAS INSPECTOR ✓ Y.f..
Check# / Z Y7 i
3977
Ste\
jw MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO CASFITTINC
(Print or Type)
LU
HDU (?A/,�UU�.A, ,Mass. Date.3 �7 ,20-0-1,— Permit# 7
Building Location 657 3 0 Woe-D S % wnerS Name pr-7-C- 2 f�OWIPk D
r pe o ccupancy LtJ(y'L t-
IN .
New❑ Renovation❑ Replacement(] Plans Submitted: Yes❑ No❑
UJ
Y z ~ to
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It
Z w (n W O U Z Z It
LU
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c� cwiLU _ z e � 0 0 W
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SUB-9swr
BASEMENT151 FLOORl
2Nu FLOOR
SKu FLOOR
SIN FLOOR
6TH FLOOR
71"FLOOR
SIN FLOOR
M
Installing company N5me ec one: a ca te
Address �`� /`J /Z`LJo ,Qvj�n 42ivodV ❑ corporation
Business Telephone—9 r-) 3 cfZcf y� Partnership C_/�
`' ❑ Firm/Co.
Name of Licensed Plumber or Cas Fitter
INSURANCE COVERAGE: "
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142.
Yes 1( No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy other type of indemnity ❑ Bond ❑
i
OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by chapter
142 of the Mass.General Laws, and that my signature on this permit application waives this requirement
Check one:
Signature of Owner or Owners Agent Owner ❑ Agent ❑
I hereby certify that all of the details and Information I have submitted(or entered)in above application are true and accurate to the best of
my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be In compliance with
all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Lijvws. /
Typq of License: ��A �✓
sy 'Plumber Signa Va of Licensed Plur ber orCas F iter
Title
Gas fitter
C'ty/TOwnMaster License Number �-3 /
APPROVED(OFFICE USE ONLY) 0 Journeyman
FROM FL I NTLOCK, I NC. PHONE NO. : 19766834436 Oct. 18 1998 10:43RM P2
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�131'2O''7"w STREET MPKNN :M,
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THE PREMISES AND THAT A!.L APPARENT
fASEMEN7S AND ENCROACHMENTS APE LOCATED
THIS PLAW IS INTENDED FOR ZONING AS SHOWN. THE STRUC71JRE SHOWN 'XNFQRMr,
PURPOSES ONLY, IT WAS PP.EPAREO TO THE ZONING LAWS OF rr(C MU141CIPALITY
FROM VIS71NG PLANS AND RECORDS WHEN CONSTRLIC-p, ALSO, ACCORDING TO THE
MrH Ti-�E 97RUCTURES SHOWN LOCATED Ir C.M.A./4-VD, FLOOD INSS✓,.IRANCE RATE MAP,
O SHOU�01 OT BE USED FORUMENT Y. TIMIS PROPERTYN CONIVUNITY OA EO 6/2/33,THE &RUbTt� NOT I.L'GArEp
LINE DETERMINATION. IN A4 PQTAPI IC49?% Inn Ya e1 MAM IJAV.61% sn.rr
CERTIFICATE OF USE & OCCUPANCYit, y
Town of North Andover
Building=Permit Number � Date
THIS CERTIFIES THAT
THE BUILDING LOCATED ON Oe •r 3 0 S Gy d St
MAY BE OCCUPIED AS .Si hamI c F:r& ,, V IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
o� "°"T;,, CERTIFICATE ISSUED TO r.-.. /t%Z Af 1/0 W'A V. p ADDRESS '3 0s : C)
o ct Sfi
''^CMU' ` Building Inspector
i
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t�., i.�,.r� -.' ,t.,� _.fd t3 ,� ": ..t {v s::t °.... .., �t t � `•r3� t S
Town ® Andover_
.,
No. qJ7L
dover, Mass., —19W
i .. .. .-i.. �.
LAKE
O'9'COCHIC HEWICN
RAT E D ph,
BOARD OF HEALTH
PE� RIVIIT T DFood/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT 0 A�� 't ee Q
4 ..... ............ ........... .. .......�........................................................................ Foundation /
has permission to erect... j....... a buildings on ....&..#F3..........d.1 ...St................. Rough
to be occupied.as.....Sew l�.........�_4�1 .1..�. .. .R... �4 A 51...�....................... Chimney ��-
provided that the person acceing this permit shall very respect con form`to the terms of the application on file in Fl
this office, and to the provisions of the Codes and By-Laws relating,to the Inspection; Afteration,and Construction of nal AW ///
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT FOR FI AMrJBUILDING Rough eq`, �5�3
5 s�
PERMIT EXPIRES IN 6 MOWS. 3 FEE PAID;.__.___ ELECTRICAL PEC
UNLESS CONSTRU N TARTS ou
.............
. .... .. ......... ..... .. . ..
B LDING INSPECTOR
Fina /
Occupancy Permit Required to Occupy Building As/INSPECTOR
Display a in Conspicuous Place on the Premises — Do Not -Remove Rough
No Lathingor D Wall To Be Done Final dk tr
Until Inspected and roved b the Building Inspector. FIRE DEP ENT
P Approved_ Y � P Burner
Street No.
R-ec V6 Smoke D