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Miscellaneous - 657 SALEM STREET 4/30/2018 (2)
657 SALEM STREET 210/065.0-0050-0000.0 Date.....OF . &oRrs, TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING • This certifies that ............. ,.ap..av.......... ..................... has permission to perform AL........ ..................................................... wiring in the building of-S..... 5.......................................................... at ..... .......S,�...........................................North Andover Mass. Fee... .....Lic.No. ................ . .............. LECMCAL INSPECTOp Check# 13 S`i 1-2272 t Y a � 0* 7-- Occ%mnqmdFeeChwkcd BOARD OF FIRE PREVENTION REM ATIONS 1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK an�taue��tffi ��� .c_oa��czs2sce+��zoa (PLKMPMffWIlK0R3YPEAUMF0Rba3T" - Datc Oty or Town of IYI,r 441 141�do ro the&Temr of Wvrs. Bye spocadam theuademped gimmiceofhis orhwkftitiaatoperformthe dec6iaal vm&desmUmd bed w. Low oftva dE OwnerorTenmoit t'LTiyP ���,. �rS eT�honelsa Owaer's"dress 19- 1 Z-�t b MS permiE in eonjmcffoa with s building pmmW Yes 0 No ( ApprepriateBox) _ Parposeof7Saaildmg IItaTdpAuffiorbalionNa/� 7 17 -7 .5 Existing Service /o 0 Amps /),D 12 Y'D Vohs Ovwhead® u-ndgrd❑ Na ofMebw / j New Service ?o a Amps /1 o A Ya Volts Ovatead[- Undgrd L[ No.aflgete^s j_ NinalwafFeeders and Ampa&y Location and Nature of Proposed Xlechiod Wor[c t)p C it N 4 e_ 17 61 c 4_ Z 1 n }t/✓%/ Li c 1115 /-c-4,f c-/--,T- e /2 ec, gty / /:, 1314IAe ' table be waived by Oc ix ig M of Wv-rs. L efReemed Lm dnmh= ��' No.ofCcn Smp.(Paddle)Fms o. HVA NO.GrUndnakeouffift No.UrBot Hobs Generators HVA ofLmmfmaires pool © ❑ °ft"U'U, &ofRecqdade OaHets NO.OfOnnmaers FIMALARM o:ofZoaes o.ot'Swadw No.of Gas Bmrners loldefloaDgko y� a.ofRsngm NaofAirCoad. Tons NIL ofAiertingDadm of WasteI)3sPosers Bumber Toials °W a of Self-Coutmftwd Alerfma Devices No.ofDbhwashers SpaWAreaHeating Kw Lmdo 0 Of kw HeaffmgApplisaces BWNa of cesor Fanivalout° Sibaso.' BeatersHW °` Bauas�s Xm ofof°Dafto or o:Hydnomesssage BaHYtvbs Na of Matins - Total$P Ta as vvjmz: No.ofDevjces or FAndvOent ' OTSSR: Attneteide7m7ifde�arasaegnirrdhptloeofWmes l sVmftd Value ofElechical Wolk (WheWnqohcd by 1O&7-) WcffktDStut -InspecdonstoberequesUd;avd&Mcx:ue DMIUB M COVEUAG�. Udea waived t ie,c�••«•? '. • by anope�rfcetheofebx�ricalwo�c�yissmiless the i'iom mpaovidm puff ofgability i stuanc a inatudso 'bmwoeted op medo a cavczW or tssnbsbntW cqukmtenL The irmigoEtl des batt sacb coverage is in fes,and has addibibilpmefefsme to thepennit issomg ofm date; a9XHLWCEt2 BOM 0 rnHM❑ ( :) ��i�� mid � s�lQf t7f2�rl�Ji Olt�flS 4Olt�S�R1�O71[l FnwmArdjkBUddV electric Inc. XJC-NO»92097 A I.ieeusm Vincent B. Landers deg; LWNW 23 684 B ffoppswbkvzw Infer „affirm) BST& 378='9'15=4-455 Address: 24 nolgate 'fir 7fT.Andoy •r, Ma o18AIS .AILTeLNa:` *PerIvL01- c.147,s.57-61,secuft vm&nqub=Dcpadmt=ofPublicSofet -.T Lioem= Ik-Nm OWIGX'S I%*ERANCB WATVXJb Ion awwclba be l f omsm does lmt kam the SablWy iasazance mw=WnxnmUy erdChmby kw. Bymy s'sg�abeia w Ihereby�uaivetbis�ammt Iamtbe(checkane ow>a�r 0 ovmer'sa eat. Sigostare� WephomNo. PEEM1"IFM S r t_ 8 'Ile �i�/ r The Commonwealth of Massachusetts Department of Industrial Accidents ! Office of Investigations 600 Washington Street Boston,MA 02111 T www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name usinesdor tionftdividaai : Address. City/State/�Z"i�p:�' a r/-t'r, Cl Phone k_ 1��" 225 — Z� 5--`_ AFI an employer?Check the appropriate box: Type of project(required): 1. m a employer with 4. [] I an a general contractor and I 6. ❑New constriction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in employees and have workers' �'��Y- 9_ ❑Building addition [No workers'comp.insurance comp.insurance.1 required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions m el£ ' right of exemption per MGL ys [No workerscomp- 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[:1 Other comp.insurance required.] sAny 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 subcontractors and stabs whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'conymmadon insurancefor my employee. Below is the policy and job site informatiom hws wince Company Name: rGrL Policy#or Self-ins.Lie.#: �IC_� �� Jam' Expiration Date: Job Site Address:- S Gi�i�, 5 /vim,-AA A,5/eiV&-City/State/Zip: d& eV 1,6Z 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 i&ander the pains and penalties of perjury that the information provided above is true and correct Si Date: L _ l Phone#: ?�c5' ��5 use not write to area,to he conrkted by city or town official City or Town: PennWLicense# 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#: Date..5......... ...�Y....... 10528 OIRTA, TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING This certifies that..... ***6**/?*'-*-*7............................................................ has permission to perform........ ............ . ................................ plumbinz in the buildings of .f. . .................................................. .... at...........4Y7 North Andover, Mass. ...... .... Fee.7.0........Lic. No. ..................................................................... 1--*' PLUMBING INSPECTOR P) Check# Date.............. ... .......................... . N°RT/y i 3?'��" � TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION sgCHUS� Tlus certifies that .....)....1...ex........................ . ..:.�..... .............�..:.. 1.�.... .. R has permission for gas installation ..................................: in the buildings of ..... '^ �' ................................:................................................. ; 4at.........4r.7....... ............ ...... North Andover, Mass. 'c GAS INSPECTOR Check# �"J 9277 � 7 � 1'/y 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK WCITY MA DATE C _( PERMIT# JOBSITEDD S OWNER'S NAME T POWNER ADDRE STEL ( _ FAX g� TYPE OR OCCUPANCY TYPE lam! QOMMERCIAL EDUCATIONAL © RESIDENTIAL Ej,-' PRINT CLEARLY NEW: M RENOVATION:� REPLACEMENT: Q PLANS SUBMITTED: YES® NO Ell FIXTURES-1 FLOOR--> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I ( _-_ I _- ! I I --___f _i _ f DEDICATED WATER RECYCLE SYSTEM 1 _ _.-.1 _____( DISHWASHER _I __.. .(' - � .. _1 _._{ .__._._.. 1 _� -__ ___..) .__._(' I _-.-_-{ DRINKING FOUNTAIN _I __.__...1 _-.--_{ I ._.__._f - _l._-_--_-� -_-_-._I ___...._._( � .._._._J _ _ ._._.._I FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) ---- -KITCHEN SINK LAVATORY _ ! _ 1_I �=1_ ROOF DRAIN 'SHOWER STALL SERVICE/MOP SINK _._—I E TOILET - URINAL _-A WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE T E TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i� OTHER TYPE OF INDEMNITY D€ BOND ©i 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 � AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true d accurate to best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com i n ovision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME- A�-1 �Y- _ LICENSE# { IGNATUR IMP a JP�{ r, RPORATION a PARTNERSHIP D# I LLC U� COMPANY NAME ADDRESS CITY STATE ZIP L D TEL FAX '® CELL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION (OWES Yes No 5 eh e-11 Y Z"I THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts - -' Department of Industrigl Accidents Office of Investigations 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): • J Address: i City/State/Zip: Phone#: 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.El 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. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised they 10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i 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. i Homeowners who submit this affidavit indicating they are 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 1s providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. I . 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 requiredunder 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 certtfy under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: 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.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: 1 Information and. Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employeiis defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a j oint 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 loeal 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 of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to 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 permittlicense 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston}SIA 02111 Tel#617-727-4900 ext 406 or 1-877 MASSAFE Revised 5-26-05 Fax#617-727-7749 www-mass.govfdia -` MASSACHUSETT UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY _ MA DATE r ERMIT# : I�7 lT_ _ 1 JOBSITEADDR a �OWNER'SNAME �„�cj�t--�t�-✓`� r G OWNER AD ESS - 15-t- TEL NWE TYPE OR04 PRINT OCCUPANCY TYPE CJMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW:E1 RENOVATION:[REPLACEMENT:® PLANS SUBMITTED: YES[I NOa' APPLIANCES'l FLOORS-� BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - ---- - --- - - - - COOK STOVE I DIRECT VENT HEATER DRYER FIREPLACE [ - ❑-� _i --��— f - - FRYOLATOR FURNACE GENERATOR GRILLE _ -( --- _ - - - . _ ❑J - _ -== -- - - -. INFRARED HEATER _*_�J _ LABORATORY COCKS MAKEUP AIR UNIT OVEN - POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST ONIT HEATER �Z UNVENTED ROOM HEATER LL WATER HEATER f OTHER J f INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 15NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d OTHER TYPE INDEMNITY ❑ BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true an accurate to the t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia e p vision of the Massachusetts State Plumbing Code and Chapter 14 of the General Laws. PLUMBER- ASFITTER NAME LICENSE# GNATUR MP MGFell JP ®1 JGF { LPGI CORPO TION #/ PAR ERSHIP LLC ❑ ® LTJ ©#� E-]# COMPANY NAME: - ADDRESS CITY STATE IP TEL j ,� j FAX 1 CELL D - Gv elp ROUGH GAS INSPEGTION NOTES THIS PAGE FOR INSPECTO R USE ONLY FINAL INSPECT NOTES TES Yes No THIS APPLICATION SERVES AS THE PEI MIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NO rES 7 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,�� Please Print Le>?ibly Name(Business/Organization/Individual): r�'G Address: �55 ty p:_ - c.t? il�r C,� L�� L1`Z d �Ql_7`� Ci /State/Zi Phone 7 Are Y9.0 an employer?Check tappropriate box: Type of project(required): 1.ET I am a employer with 4. ❑ I am a general contractor and I 6. ❑Ne ongruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7 emodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in an capacity. workers'comp.insurance. 9 . g y p ty• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.01 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions =self. Wo workers' comp. c. 152,§1(4),and we have no 12.n 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 ai•e 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.#: '51901 QUI Expiration Date: Z S i Job Site Address: b ���2 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 requiredunder 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 D for insur a coverage verification. Ido hereb ce t pal nalties ofperjury that the information provided above is true and correct. Si ature: Date: Phone#: 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#: Yl Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire, 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 of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to 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'camnensafinn im ance If an LLC C or-LLPdees 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 r 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 permittlicense 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 Commonwealth of Massachusetts Dopartment of Industrial.Accidents Office of Iavestigat>Ions 600 WasWngtou Street Boston,MA 02111 Tel,#617-727_4900 oxt 406 or 1-877rMASS.AFB Revised 5-26-os Faze##617-727-7749 �.mass.gov/dia IMPORTANT NOTICE PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. Fold,Then Detach Along All Perforations 0MM0NWEa►LTH OF MASS�kCHUSETTS PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE:: ' LICENSED AS A MASTER PLUMBER` cc TIM_OTtiY G A F F N Y z 15 COLGA�TE OR � .Fts�� ��� ' o J NQRTH ANpOUER1A 01845-1806 I 9067 05/0:1 209929 �. 44 ,"I OW 1:17W'710051=1 ETET07MITip-m-, Location / ,6A No. 02.3 y Date ��G NORT" TOWN OF NORTH ANDOVER O? ♦ 1 • Ow Certificate of Occupancy $ �'�S' •t<�' Building/Frame Permit Fee $ sACHUs Foundation Permit Fee $ Other Permit Fee $ 73 TOTAL $ � Check 17096f Building Inslfwctor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �y - -N..°b' 'z ra.<:_ ,... " We- BUILDING �.._ , „ � � F _i� BUILDING PERMIT NUMBER: DATE ISSUED: _ � M SIGNATURE: Building CommissionE for of Buildings Date 3-/-U SECTION 1-SITE INFORMATION I o1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided R red TProvided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIE/AUTHORIZED AGENT 2.1 Owner of Record Na a(Print) Address for Servic6 Signature Telephone "2.2 Owner of Record: Name Print Address for Service: M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Superv'sor: Q (�Z License Number Address ExpiratioA Date tgnature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name / Registration Number AddressrM Z Expiration Date /� Si nature Tele hone G) SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be `01WIC �`� USE Ol!ILY Completed by permit a licant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC r 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZAT ON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date ' SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject , property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/A ent Date Mill, 111 _ MEW" NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2ND 3RD SPAN DM ENSIONS OF SILLS DIN ENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlVINEY IS.BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE y North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Build.ing Permit Number is that the debris resulting from this work shall-be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. I The debris will be disposed of in: 1 (Location of Facility) ignature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i W[� The Commonwealth of Massachusetts - `"' Department of Industrial Accidents F ice of Investigations Boston, Mass. 02111 as Workers`Compensation.insurance Affidavit Name Please Print Name: r /w �ge_ Location: 4-J Citv Phone # 7,L 1_ m Q "Z 7�{ a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity sy I am an employer providing workers'compensation for my employees w orldrig on this joh. Com. nano name: Address Crr Insurance-Go. Policy# Company name. Ago":— rance Co.Insu ;. False to secure coverage as required ander Setbon 75A a ttli�t 1S2 canlesdtorthe bn;wsition oi<airrww,at.:p of awfihe uXso gh anctror one yeare bnprianrMr2beSame�f� lL2 fiaeya4rags3i�st a uriderstand Out a copy d this statement maybe forwarded to the Office-d to estigawris cif ttte bMm- r coverage vie on. l db hweby cerW w7dhr d�P P / �PeJwY est the arfam�atiarr providled aAuve is truB anat:Qors+eet Signature Date Print name l' I'A tL -Z/� / 7 Y Offidal use only do not write in this areato be completed by city or town offish CA Y ortj Tomrrw __ ::P'edrRicr�siny.. rtirtg aChedr,Vbm w date,esponseisreguxed Gt seleChnaWtl Contact person: Phone A He.—lift Depj El El Other ' ✓lie 1Jam�nreo?uu ✓�aaa Board of Burldmg'Regulat�ttns 0— Standards HONIE`IMpROVEMENT CONTQACTQR Registrbtidns 14034$ Ezpir 't! 10/14!3005 Efype ;DBA t MACKINNON HOM IMPROVEMENTS BRIAN�WCKINN6N , $IILI;RICA;MA 01862"' Admimstr-0 Jlze��d�iraaz�iie�d� o�.%�aa4ac�ivaelT� .BOARD OAF BUILOING REGULATIONS' License CONSTRUCTIONy$UPER/ISQR' �Numbe�,C:S' -, 07G029 I {Bir�fc�a�e��05/1'8/'196$• N, zpir�s Ov/181 �05 Tr.rigs 13323 74 i ARestr�cte� BRIANrE,:MACKINNON �, //• 4MT PLEASANT r BILLERICA, A' gaministrator L ORTh� 'q Town of k,. Andover 0 e ��0.� �OCHIC EWICK� lover, Mass., � A ,V .9�RATED AP�R�y 3 V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................ .. .. ........................ ............................ Foundation 10 has permission to erect........................................ buildings on..�. ...... ............................... ..................... Rough tobe occupied as ..... ............................................................................................... Chimney . ........................................ provided that the erson accepti this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST � ELECTRICAL INSPECTOR Rough ........................................................................................... ................... Service BUILDING INSPECTOR Final 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 ` Street No. • SEE REVERSE SIDE Smoke Det. Location � - - -- F� No. / Date R= toRTM TOWN OF NORTH ANDOVER zr-z"W"dAbL 10 a ? : Certificate of Occupancy $ .7Q-Q U Building/Frame Permit Fee $ 112 U U ro Foundation Permit Fee $ s�cHus Other Permit Fee $ "— Y` Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 24, �U z Building Inspector 7231 �'•"' Div. Public Works PEbt�11"T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. d L `AGE 1 MAP 440. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ` ZONE I SUB DIV. LOT NO. I LOCATION 7 .1�� PURPOSE OF BUILDING Tia y; v 45V OWNER'S NAME r 'Crap NO. OF STORIES [_� SIZE I �� v� �o C'2 _ OWNER'S ADDRESSSa �1`fg BASEMENT OR SLAB ARCHITECT'S NAME J O A v vo, O �QIZE OF FLOOR TIMBERISY' IST ��t'� 2ND 3RD BUILDER'S NAME S r' F- SPAN OBJ Y�. to DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS --- DISTANCE FROM STREET "" POSTS DISTANCE FROM LOT LINES-SIDES REAR "" "' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION Q THICKNESS IS BUILDING NEW SIZE OF FOOTING OO o X w IS BUILDING ADDITION ` QJ r MATERIAL OF CHIMNEY V IS BUILDING ALTERATION I CIS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODEyes IS BUILDING CONNECTED TO TOWN WATER �p BOARD OF APPEALS ACTION. IF ANY CG. JJ IS BUILDING CONNECTED TO TOWN SEWER 4 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION �S p LAND COST SEE BOTH SIDES ,/,] O 7 e— �!'GIJ� EST. BLDG. COST �V �q PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER . FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY r ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR eS DATE FILE BOARD OF HEALTH SIGNAT (50FOWNEROR AUTHORIZE A ENT FEE 17 0 { p� G i Q (� // x PLANNING BOARD PERMIT GRA o OWNER TEL.# b CONTR.TEL.#_zz 19 CONTR.LIC. BOARD OF SELECTMEN i a/a BUILDING INSPECTr N �r BUILDING RECORD s 1 OCCUPANCY 12 SINGLE FAMILY SrORIEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT A D :gNCE FROM MULTI. FAMILY OFFICES � LOT'LINES AND EXACT DIMENSIONS OF BUILDINGS. W� ORCHES. GA- APARTMENTS , RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH 1 CONCRETE 3 1 2 13 CONCRETE BLK. PINE BRICK OR STONE HARDW D PIERS PLASTER — DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M T AREA _ 'J, 1/7 '/. FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 I 2 3 DROP SIDING CONCRETE ��_ WOOD SHINGLES EARTH ASPHALT SIDING HARD"J D _ ASBESTOS SIDING COMfdCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING - GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) ? FLAT I SHED WATER CLOSET _ 0,' ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR 1-4 TILE DADO 6 FRAMING II 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 GASOI L B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING T A M E R I C A N I N S T I T U T E 0 F A R C H I T E C J S AIA Document A 10 7 Abbreviated Form of Agreement Between Owner and Contractor For CONSTRUCTION PROJECTS OF LIMITED SCOPE where the Basis of Payment is a STIPULATED SUM 1987 EDITION THIS DOCUMENT HAS IMPORTANT LEGAL CONSEQUENCES; CONSULTATION WITH AN ATTORNEY IS ENCOURAGED WITH RESPECT TO ITS COMPLETION OR MODIFICATION This document includes abbreviated General Conditions and should not be used with other general conditions. It has been approved and endorsed by The Associated General Contractors of America. AGREEMENT made as of the second day of May in the year of Nineteen Hundred and Ninety Four BETWEEN the Owner: Kevin And -JNMIE Spicer (Name and address) 677 Salem St. North Andover,Mass.01845 and the Contractor: S. P.DeFusco General -Contractors (Name and address) 7 Austin St . Methuen Mass. 01844 The Project is: Inlaw apartment (Name and location) 677 Salem St. North Andover,Mass.01845 The Architect is: Owners (Name and address) The Owner and Contractor agree as set forth below. Copyright 1936, 1951, 1958, 1961, 1963, 1966, 1974, 1978, 91987 by The American Institute of Architects, 1735 New York Avenue,N.W.,Washington, D.C.20006. Reproduction of the material herein or substantial quotation of its provisions without written permission of the AIA violates the copyright laws of the United States and will be subject to legal prosecution. AIA DOCUMENT A107-ABBREVIATED OWNER-CONTRACTOR AGREEMENT-NINTH EDITION-AIAq1 -@1987 THE AMERICAN.INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, NW, WASHINGTON, D.C. 20006 A107-1987 1 WARNING:Unlicensed ohotoconvina violates U.S.couvricht laws and In sublact to lanal nma&rietInn. s a i ARTICLE 1 THE WORK OF THIS CONTRACT 1.1 The Contractor shall execute the entire Work described in the Contract Documents,except to.the extent specifically indicated in the Contract Documents to be the responsibility of others, or as follows: Contractor will remove existing garage and dispose of properly Contractor will install new 1500 gal. septic tank. Contractor will construct a Eighteen by Thirty Five addition ( inlaw apartment ) . Contractor is responsible for the excavation , frame. siding, roofing, and all interior work. Owner is responsible for interior floors and painting and staining.Contractor will be responsible for foundation. Contractor will regrade earth around new building owner will landscape. t I ARTICLE 2 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION 2.1 The date of commencement is the date from which the Contract Time of Paragraph 2.2 is measured,and shall be the date of this Agreement,as first written above,unless a different date is stated below or provision is made for the date to be fixed in a notice to pro- ceed issued by the Owner. (Insert the date of commencement, if it differs from the date of this Agreement or, if applicable,state that the date will be fired in a notice to proceed.) May 9 , 1994 By approval of local building department 2.2 The Contractor shall achieve Substantial Completion of the entire Work not later than (Insert the ccdendar date or number of calendar days after the date of commencement.Also insert any requirements for earlier Substantial Completion of certabi por- tions of the Work, if not stated elsewhere in the Contract Documents.) July 8 , 1994 weather or material delays may extend completion date subject to adjustments of this Contract Time as provided in the Contract Documents. (Insert provisions, if ant',for liquidated damages relating to failure to complete on time.) None ARTICLE 3 CONTRACT SUM 3.1 The Owner shall pay the Contractor in current funds for the Contractor's performance of the Contract the Contract Sum of Forty Eight Thousand Three Hundred And Thirty Dollars ($ 48330 .00 ), subject to additions and deductions as provided in the Contract Documents. AIA DOCUMENT A107-ABBREVIATED OWNER-CONTRACTOR AGREEMENT-NINTH EDITION-AIA° -@1987 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006 A107-1987 2 WARNING:Unlicensed photocopying violates U.S.copyright taws and is subject to legal prosecution. � r 3,2 The Contract Sum is based upon the following alternates,if any,which are described in the Contract Documents and are hereby accepted by the Owner: (State the numbers or other identification of accepted alternates.If decisions on other alternates are to be made by the Owner subsequent to the execution of this Agreement, attach a schedule of such other alternates showing the amount for each and the date until which that amount is valid.) Non e 3.3 Unit prices, if any, are as follows: Cabinet and counter allowance $2650 .00 i ARTICLE 4 PROGRESS PAYMENTS 4.1 Based upon Applications for Payment submitted to the Architect by the Contractor and Certificates for Payment issued by the Architect the Owner shall make progress payments on account of the Contract Sum to the Contractor as provided below and else- , P g P Y where in the Contract Documents.The period covered by each Application for Payment shall be one calendar month ending on the last day of the month, or as follows: $5666.00 at the time of commencement $5000 .00 at the completion of the foundation $10000 .00at the completion of the rough frame $5000 ,00 at the installation of roof,windows, and doors $10 , 000 .00 at the completion of all rough inspections and siding $5000 .00 at the completion of drywall and priming. 4.2--Payraeuts due,%uduclpaid-uader.the Cw=aus"Lbear intecest from the-d=_pzy iewis-dueattherate statedbclo'&,_orin the absence thereof,-at-the}egal-rite-prew iiliflg-f+ofi-ttkae-te time_aE the place where-t-k@-Rreject-is dared- (Instztrute�fl�tlecesLagrPed7sDar..1l�+1t3'.!———— $ 5000 .00 at the completion of electrical and plumbing $3330 .00 at the completion of finish work and clean up (Usur),laws and requirements under the Federal Truth in Lending Act,similar state and local consumer credit laws and other regulations at the ou-ner's and Contractor s principal places of business,the location of the Project and elsewhere may affect the validity of this provision.Legal advice should be obtained ulith respect to deletions or modifications,and also regarding requirements such as written disclosures or waivers.) AIA DOCUMENT A107•ABBREVIATED OWNER-CONTRACTOR AGREEMENT•NINTH EDITION•AIA° •©1987 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006 A107-1987 3 WARNING:Unlicensed photocopying violates U.S.copyright laws and is subject to legal prosecution. EXIST. 12'x 7 S'SHED (90 S.F. ) N/F �(L FTTE KEL LOWA Y AREQt 4 , 346 _ S.F 28 N IF ROCHE FqM/L r TRU. PROPOSED `V ADD/TION 0 EX/ST �rj , 35 - N r r 23.Z DKK 34.4 D`Ck EX/ST. D`YL G EX/ST. 32.8' !NLG. --- EX/ST/NG 40.6't IGQR,4GE # 667 # G77 62 ± #G67 I i 157.87' - PUBLIC SAL EM l�V/DTH VARIES 5TREET NIF NIF NIF RAYMOND RICHARD AUGERI KARL LETOURNEAU L/PPM4NN HE PROPERTY LINES SHOWN ARE G EXI5TING OWNERSHIPS AND THE AND !NAYS SHOWN ARE THOSE OF STREETS OR WAYS ALREADY NO NEIN LINES FOR D/d/5/0N OF PIPS OR FOR NEW WAYS ARE SHOWN. CHAP. 41,, SEC 6J X FORM U - IAT RELASE 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 Number Parcel Subdivision Lot(s) ,Sytreet SA/ M St. Number V************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Ve) CA11M. - z�2 Date Approved Conservation Ad istrator Date Rejected Comments gxX 4fl Date Approved C[ Town Planner Date Rejected CommentsG'M� \( \ � Date Approved F od Inspector-Health Date Rejected Approved A � .� � /1 Date pp L9� Septic Inspector-Health y� /Date Rejected Comments '4 (5e: / Public Works - sewer/water connections _ - driveway permit 1 � � ts'—�' : 1 I -�cd�F�C�� � s/✓"�"�Ls� /Fire Dept . ,qartmen '• Received by Building Inspector r. +n .7 V1Date f;3 r,r` MAY - 6I - �+�:.� t - •, t. a _� � `.�,i� v\� ' �rt�ti��y +.W P Sil r 4 -•�� �-w i.i�t`.�q.r '� �, ` y�a. d to I � t ►+ 'fit+ tti t') 1 C7 I J ►-� O s� O `z ►tt 1-4 o \. i I E NORTH FTowno6Andover o ��441 No. 16 T ° '- LA � dover, Mass., COCWCHEWICK ORATED BOARD OF HEALTH ` IT T Food/Kitchen �'y 4 "+ -. Septic System R M BUILDING INSPECTOR THIS CERTIFIES THAT..........wro.Amcelp.Ar......I.. .of. .... ............................ Foundation ....40.4 Or.&....��' �,has permission to erect.�.�.��.�L� buildings on .. ... .....7 ................... Rough , to be occupied as., p ,�. � �.. �� .....' � �. .. Chimney .... ...I..l� provided that the person accepting this permit shall in every respect cogrorm to the terms of the application on file in Final t : this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough i ' Final I #0y#.WERM1T EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS i ' • Rough 011 ............ 114 ... Service BUILDING INSPECTOR Final � Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final F 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 PERMIT � � ��� r 77 7y `"' r,. ' •`f 'C .+ 'G. ,a, a a ,._. ..w ; w-S '� Ea wi•H r P } Ay' �,+ ai"' k �. 4_ E..: g t :4 '+ c +tw sy ♦ •t '�;t r a ''.6.'.aa ,..•; .3w` wet° i �' !y 4 �5a::.. r i >S na r ,j•• , •, � d YZ ll CERA IF. CAT ;� JvFl1SE � �irkA`Ne 'Y` T � *��-..tea•, y'� Y�<'�"4t•7 �.,�-1,� - _y'" .s. +G�nu'..�,,,,,.o.... � . �aurrn�,:of :North aAndo�er� 4 .J'.- r ,...-cR-`" ;-r .e-� c.>..w �,, 1'.�t : r•3,3i,„ .'�- ,-. ..�,r;�+��__ , .,.�'� >.+� �--� - 't��a I- e�w T : S:�t tv - :` � 3t�ap.3a_,_•�, �., s ,�,o- s, n-�.� ,R tk.�-��.r-rL�r� ,r�+y..••�, �i��: _ .�4�aw���. r � .` Permit Numbers? - [ at _ .a .a..� "tet tYn" r'+., ,� .�,Z .m,...�.���_� �aYIIla7�. � >,.vt ; ��"'�'"rx�i�..�:��,.� 4L'�•'3��a tet.. ^s-• '-r s .. x-a.�� =•u�r a ' .zr�errr� i r. ;; THE BUII.DING LOCATID ON 677 SAL>±M STREET - `�' d',k v,5: ., - s.. _• ars,a rWs..a..�aar,,«+{�`rlew""+.� .�,.�X" nr'�4a �.�'�ac- 4'a�'' �' '?r"y F��" .fix ;a. eA.F I':�.e�. 'sfi�v�-�s..t L•v e '�..t�,. `",,,, .- q �- *� •�9•�R..a�T'+w.#'7@�'W��5�'a�«.xzes!'.$+�}rc *'tr��+rea^ ,�i-".f"ee.$ s ,�> �a<p1•w- x,yr ..�*afk?r`.aaa '�n7d'-` b� yam!- . MAY BE OCCUPIED AMILY�SUTTE-ADDITION peals--INACCORD ` 4 a:cz..aa_..x: ,a� .,..'aa:.' .s.s...srr.3.:.. '.�c�oa:u:� �r=_�T_�•rr:�txa_' `.sH ;+:, ...... ({Q .. v a - - �TI��PRf?�? Ol��OF`3'HE�I�IASS�4►.CHUS ETTS STATE BI3ILDIN-G'�OD�AND �� SUCH OTHER�tE..... s•. �,r ;?a+,';' - - t'' `; ""�'y. r�tS:.»,..#:*dr: w. "' "-`,,.may" ' :- _ �.. _ c 00".°eT"�� -=..CERTIFICATE LSSUED TO x J & evin Spicer anise K 677-SalemSt. µ. . . . 3a:i��95f r4 �.. T '.'F'>KIA SL"G`WL of3.A�."+'R]X38P'i9'l`�'9!•_JSk..fE1"LSK�'L215tG'.?tlFb2"'S4..aSSCS'ia'G. A-,J.T F t 1 1 'Y P.S.Y L,. 4f+':. bS'-aNR'J^3�if t�iR��rf'J�t.6..S.NAA�JI.SS. z�+-.. -TT•....^ -„ a^�__�....... i. .- _ .C'. 'tea iL_ "Y'x -.'.4"^.^.tY�Jt�'C.Nb^!'.i'C 2T.�._ �'SdN�I�94Sn3'1Rf'��+Y'�%`MY.+ e: S"^K.i,e*I &ER/) _�'?RfM4i1�]ISJ9].i1FY F�RCl2f9at'6aAbiv@"6XGA�C +..FY3A�i1JkRt'e€"�.�.s8�6GT iLi 9Yi.2 �4.. J^'+ 'i.Y*+^'^'t 1MiP"l0tlLifr '}'NS'&X'v 9E5I,"T31�1°.'@9nT`&'0>'k�4G=e' - alb._ az;:s zr-. ^._•?"�'�'kSa�;� :°• t. ._ ! Y 43. 4 - - - / NORTH t F t o o uAndover ® Y N � No. . 16 - ?, urt dower, Mass., /yOV /D 19Ap C ) BOARD OF HEALTH PERMIT TFood/Kitchen Septic System '�i / l �) BU �tl CiE�'Iris✓/., •....f. .d , DINGI�S P ! TOR L Z ( THIS CERTIFIES THAT.......... ... . .. ..�.. ... .... . . ,......... .. �� Foundation��lJC,,S ._�?�� P.? 6ro.�Ar#4y. ..4'*r................ a , P� has permission to erect./.,���.��.�/. buildings on.. ... ..... .. .... .. . ......... .... ... .. . it ugl,� to be occupied as p �.r�.� i.�t, i.. ......fru.t.,t:E..... ....A$ `. .. Chimney provided that the erson accepting this permit shall In every respect coifform to the terms of the application on file In thls�offlce,;and topthi provisions of the Codes and B Laws relatingto the Inspection, Alteration and Construction of F,nal {J/('' Buildings In the Town of North Andover. PLUMBIN SIN'PE ECTOR i,VIOLATION'of the'Zoning or Building Regulations Voids this Permit. Gib/, € IJ ERMIT EXPIRES IN 6 MONTHS s` O� ELECTRI AL INS ECTOR UNLESS CONSTRUCTION STARTS / Rough 4A Sery ..................... uel' BUILDING INSPECTOR , r Final'' Q ""41 Occupancy Permit Required to Occupy Building GAS INSPECTOR4�Rou ' Display in:a Conspicuous Place on the Premises — Do Not Remove F,nagh ,. No Lathingor Dr Wall To Be Done S FIRED ARTM Until Inspected and Approved by the Building Inspector. I' L 6 Burner sir! ,a� r1 PLANNING FINAL CONSERVATION FINAL street No Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT yorrrry Zoning Bylaw Review Form x Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 LSSA`"°S�t, Phone 978-688-9545 Fax 978-688-9542 Street: Co '7 '3'4/ F— /" Map/Lot: G S y q 7.1 Applicant: ; Request: 414 5 c, , Date: —.1 �-a o© 3 Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zoning Z Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting 2 Frontage Complies e- 3 Lot Area Complies 3 Preexisting frontage 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building.Area 2 Not Allowed 1 I Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required Lf e S 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply L( e S 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height Lt e,5 4 Right Side Insufficient 4 Insufficient Information 5 Rear In I Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage.Complies C5 D Watershed 3 Coverage Preexisting 1 Not in Watershed p S 4 Insufficient Information 2 In Watershed j Sign A) 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district 2 Parking Complies 3 Insufficient Information 1 3 Insufficient Information 4 Pre-existing Parking RemedY for the above is checked below. Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit Setback Variance Access other than Fronta e Special Permit Parking Variance. Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Special Permits Zoning Board Independent Elderly Housing Special Permit Special Permit Won-conforming Use ZBA Large Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Development District Special Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permit Special permit for preexisting nonconformin Watershed Special Permit d- C,L.�,C Pana c The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled"Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file.You must file a new permit application form and begin the permitting process. llding Department Official Signattaf a Application Received Application Denied Plan Review Narrative ' The following narrative is provided to further explain the reasons for DENIAL for the APPLICATION for the property indicated on the reverse side: v a Z � R C/.Q- � P Referred To: Fire Health Police .ZoningBoard ConservationDepartment of Public Works Planning Historical Commission Other Building De artment I The Commonwealth of Massachusetts ` State Board of Building Regulations and T OVV Standards BU] Massachusetts State Building code 780 CMR APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OF BUILDING OTHER THAN A ONE OR TWO FAMILI Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: dOS / Map Number 65 1.3 Zoning Information: f- 1.4 Property Dimensions: •- -- - - -- - - - Lot Area(sq) / Frontage(ft) /3 // 1'rZonis District /S/�'3 Pro osed Use 8 T 9• 1.6 Building Setback ft. Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 56' 3s ' ' H3 ' �i� If 107 Water Supply 9M.G.L.C.40.4 §54� 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public IN Private Zone Q Outside Flood Zone o Municipal On Site Disposal System 2.1 Owner of Record Name(Print) ,,eAddress: c Signature Telephone 9f/8 ' 85^ 800 14 2.2 Authorized Agent: 7 t Name(Print.�� Address Ke,c/ Signature Telephone 03 - 898" O 8168 Loe SECTION 3 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE 3.1 Licensed Construction Supervisor: Not Applicable Q Licensed Construction Supervisor: License Number 11T �/ dO8gI AddressN Expiration Date 6 Address,, X3019 602- Signature Telephone898-0868 3.2 Registered Home Improvement Contractor: Not Applicable Q Company Nameii3k I Q _ Registration Number 106814 Address / Expiration Date j Ie d S NN 03-019 11 — 1.8 '0 Ga3 8Signature Telephone Revised 1997 JMC The Commonwealth of Massachusetts State Board of Building Regulations and TOWN OF NORTH ANDOVER Standards BUILDING DEPARTMENT Massachusetts State Building code 780 CMR APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OF OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: &0 S gl. Map Number 65 Parcel Number ` � �9 1..3 Zoning Information: 1.4 Property Dimensions: t Zoning District Proposed Use Lot Area(sq) 7 I{/ Frontage(ft) 818 /39 �' T 1.6 Building Setback ft. Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided 56' 35 ' ' N3 107 Water Supply 9M.G.L.C.40.4 §54i 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private o Zone Q Outside Flood Zone O Municipal On Site Disposal System 2.1 Owner of Record Name(Print) .J Address: Signature t Telephone 86 Baa H 2.2 Authorized Agent: Name(Print_ Address s 9 Signatun� Telephone 103 - 899- 08,68 SECTION 3 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: License Number 88 q 'f Address Expiration Date b I O 603 Signature Telephone898-0868 3.2 Registered Home Improvement Contractor: Not Applicable Q Company Name i Registration Number Qk*.4 ido UI14-' 1068 Y4 Address Expiration Date It e v� S NN 0301{9 O Signature Telephone 89 Revised 1997 JMC SECTION 4 WORKERS'COMPENSATION INSURANCE AFFIDAVIT]M.G.L.c.152 § 25C(6)] Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes No SECTION 5- PROFFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDING AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE 5.1 Registered Architect: No Applicable Name(Registrant): Address Registration Number Expiration Date Signature Telephone 5.2 Registered Professional Engineer(s) Name Area of Responsibility Address Registration Number Expiration Date Signature Telephone Name): Area of Responsibility Address Registration Number Expiration Date Signature Telephone Name Area of Responsibility Address Registration Number Expiration Date Signature Telephone Name Area of Responsibility Address Registration Number Expiration Date Signature Telephone 5.3 General Contractor Not Applicable Q Company Name: ak..kdoJ30; )dc,4 _ Responsible in G4ge of Construction !/ o S.CV a.rn5 Joe,�C A Address IfCdjebo N C. N o 3 o,,�9 Si atur� Telephone SECTION 10b-OWNER/AUTHORIZED AGENT DECLARATION I, %rn o Aa 6. W'111 C n.7 S / NC���J� ,as Owner/Authorized Agent hereby declare that the stateiQnts and information on the foreg ing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. O 44 63 C,M i Print Name Sigg9t re of Ow /Agent Date SECTION 11 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to Official Use Only be completed b permit applicant I. Building aalv8. (a) Building Permit Fee _ Multiplier 2. Electrical �� S oU (b) Estimated Total Cost of Construction from(6) 3. Plumbing 5,G 9�• Building Permit Fee(a)x(b) 4. Mechanical(HVAC) 5. Fire Protection 6. Total= 1+2+3+4+5 4,36 �.H'�,36 Check Number SECTION 6-DESCRIPTION OF PROPOSED WORK check all applicable) New Construction J& Existing Building Repairs Q Alterations Addition Accessory Bldg. Q Demolition Q Other Q Specify Brief Description of Proposed 5;w 64ir { WA, C-O /L X / o�at'dI�ions oc.Nkd 0-3 The. Recm- a- A Sv!k u.uiw Be-droorn e,,,ec� mo C,Ad AllCcs SECTION 7-USE GROUP AND CONSTRUCTION TYPE USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly A-l. A-2 A-3 IA Q A-4 A-5 IB Q B Business Q 2A Q E Educational Q 2B Cl F Factory Q F-1 F-2 2C Q H High Hazard Q 3A Cl I Institutional Q I-1 I-2 I-3 3B Q M Mercantile Q 4 Q R Residential Ax R-1 R-2 R-3 5A S Storage Q S-1 S-2 5B U Utility Q Specify: 'M Mixed Use Q Specify: S Special Q Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS. ADDITIONS AND/OR CHANGE IN USE Existing Use Group: 9-5 Proposed Use Group: R-3 Existing Hazard Index(780 CMR 34) Proposed Hazard Index(780 CMR 34) SECTION 8-Building Height and Area BUILDING AREA Existing(if applicable) Proposed Number of Floors or stories include ON e C O N#- 1 basement levels N/A 13/AFloor Area per Floor(sf) 30$ Total Area(sf) 3b$O1 AB Total Height(ft) 1684 SECTION 9-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No SECTION 10a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, As Owner of subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date revised bldg form/state JMC 7:=t -44 `✓- � -1 Zu T- iL C, a,cpx fZ T�S 4, Y In ID i STT _ - Pp, -� OL �pCAN GOODWIN i �. 14T LIU #793®