HomeMy WebLinkAboutMiscellaneous - 66 SETTLERS RIDGE ROAD 4/30/2018 / 66 SETTLERS RIDGE ROAD
/ 210/061.0-0110-0000.0
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
1600 Osgood Street
North Andover, MA 01845
RE: Insured: Paul & Donna Montecalvo
Property Address: 66 Settlers Ridge Road
Policy Number: BCGHWP
Date/Cause of Loss: 1/27/2013, Water Damage
File or Claim Number: 27612-R
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER
143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS,
CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and
include a reference to the captioned insured, location, policy number, date of loss and claim or
file number.
Ryan Werner
On this date, I caused copies of this Notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
Sig/TMENT
/and Date
ANDERSON ADJU CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
Ccmmerce Insurance-
11-he Commerce Insurance Ccmpany-
C3c Citation Insurance CempanySM
SM
Members of The Commerce Group, Inc."
CLAIMS DEPT. 11 Gore Road,Webster,Massachusetts 01570 (508)949-1500
www.Commerceinsurance.com
January 28, 2013
BUILDING COMMISSIONER or Board of Health or
INSPECTOR OF BUILDINGS Board of Selectmen
TOWN/CITY HALL Town/City Hall
NORTH ANDOVER MAO1845
RE: Our Insured: PAUL,MONTECALVO/DONNA MONTECALVO
Property Address: 66 SETTLERS RIDGE RD
Policy#: BCGHWP
Date of Loss: 01/27/2013
File#: CRPA51-XVTX61
Claim has been made involving loss, damage, or destruction of the above captioned
property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable.
If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to my attention. Please reference the above captioned insured, location,
policy number, date of loss, and file number on any correspondence.
ESTHER O'NEILL Telephone: (508)949-1500 Ext: 15388
Sr Claim Representative,Property Toll Free: 1-800-221-1605,Ext: 15388
On this date, I cause copies of this notice to be sent to the persons indicated above, at the
address above, by first class mail.
January 28, 2013
Coli mCC0 Companies ....COME GROW WITH US
CIC 254 (Rev.4/95) MAIL M80
Date. l/. i.>�, .`'. .... .
40RTN /
o� TOWN OF NORTH ANDOVER
41
PERMIT FOR GAS INSTALLATION
s •
SACHUS",h
This certifies that
t` has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . .
in the buildings of . .��.!o .�,��H.�, ,�
at . . . . ����. 11.�.�,5.�. . . . . . ., North Andover, Mass.
Fee.3U. Lic. No.92!! . . . . . � cL t� �,. . . . . . . . . .
/
GASINSPECTOR
Check#
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69 ► u
Date... n 9
...:......................
R
' pORTH
°ft"`° '•1"°0 TOWN OF NORTH ANDOVER
'° PERMIT FOR WIRING
�SSACNUS� r'�This certifies that ..... � .....o`...r�.e,--yrs- f. ...l.L ..................
.'
has permission to perform ..... -?.a !{ r�-� .......................................
wiring in the building of`' :�.. : .,y?.....................................
at.4../...........:w 7T tfi.�^..... ..�„ ..'..., . ,North Andover,Mass.
{ Fee�;Z5.re .... Lic.No3.J.: .............. .ii.✓ \\
. .... . . . . . . . . . ..........
ELECTRICALINSPE R'
Check #
9005
�,.
Commonwealth of MassachusettsOfficial Use Only
}� Permit No. ?CSO 3, Department of Fire Services
�. BOARD OF FIRE PREVENTIOUN REGULATIONS Occupancy and Fee Checked --�
[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 PRINTW INK OR TYPE ALL INFORMATION) Date:
City or Town of: NORTH ANDOVER To.the Inspector of'Wires.-
By this application the undersigned gives otice of his or a intention to perf rm the ele cal work described below.
Location(Street&Number) i ! �j �S �
Owner or Tenant CJ�f ���
Telephone No.
Owner's Address
Is this permit in conjunction with a building Rernut. `� —Yes No
Purpose of Building�/ vl � ❑ (Check Appropriate Box)
- "� j 9Q Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Und d
�' ❑ No.of Meters
New Service Amps / Volts Overhead
❑ Undgrd ❑ No.of Meters
Number of Feeders and.Ampacity
Location and Nature of Pro osed Electrical Work: /� l
Com letion o he olloud table maybe wai ed b the Inspector of Wires.
No.of Recessed Luminaires Na.of CeiL-Susp. (Paddle)Fans 0.0
.of Total .
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- o.o mergency ig g
d� rnd. ❑ Batte Units
No.of Receptacle Outlets � 2-, No.of Oil Burgers
FIRE ALARMS No.of?oaes
No,of Switches Ao No.of Gas Burners No.of Detection and
Inifia ' Devices
� . No.of Ranges No.of Air Cond. Total
Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number _ons KW o.of Se -Contained
Totals: '"""' ""—' Detection/Allertina Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
Connection ❑ Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of WaterNo.of No.of Devices or E uivalent
KW
Heaters No.of Data Wiring:
Signs Ballasts No.of Devices or E uivaIent
No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring:
No.of Devices oruivalent
OTHER: L!yVi C fZC/tJ��"
(A�P Attach additi nal detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
(When required by municipal policy.)
Work to Stark Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penal ' s o er�,that the p ��)
information on this application is true and complete-
FIRM NAME: G
c LIC.NO.:
Licensee:,G�U I?� f �/f /�)G Signature ,�,•
(If applicable, enter"exem b LIC.NO • Z
p "in the,heense ber 'ne �
Address: 'l �e �Il Bus,TeL No 8
*Per M.G.L c 147,s. 57-61,security work requires Department-of7 Alt.Tel.No.:'
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 agent
Owner/Agent
Signature Telephone No. PERMIT FEE: $
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The Commonwealth of Massachusetts
kj r� Department of Industrial Accidents
;V J Office of.Investi;ations
600 *ashin ton Street
Boston, MA 02111
Workers' Compensation;Insurance Affidavit: Build�Coatractors/Eie
A licant Information ctneians/Piombers
Please Print LeQibi
Name (Business/prganization/Individual): l 1 J
SIG • ��
Address: SAN 1 14
City/State/Zip: C d7^�1A �l�f (�
lone #
Areyou an employer?Check.the �
aPP�priate box:
1.❑ I am a employer with 4. ❑ I am a Type of protect(required):
employees(full andlor * general contractor and I
2.� I am a.sole -tm'e), have hired the sub-contractors 6 ❑New construction
proprietor or partner- listed On the attached sheet x 7. ❑Remodeling
ship and have no employees These sub-contractors have
working for me in any capacity. workers' comp.insurance. 8. Q Demolition
workers'comp. insurance 5. ElWe are a corporation and its 9. Building addition
3.❑ required.]J officers have exercised thEir 10.[1 Electrical
1 am a homeowner doing all work right of exemption per MGL I 1 repairs or additions
myself~[No-worke'rs'comp. ❑ Plumbing repairs or additions
P � 152, §I(4),and we have no
insurance required.]t .employees. [No workers' 12•❑Roof repairs
'Any applicant than eh ComP• insurance required..] 13.❑.Om�
eels bob#I must also fail out the section below showing their workers'compensation policy information
t homeowners who submit this affidavit indicating they are doing ail work end then has outside con
;Contractors that chock this box must attached an additional sheet showing the name of the sub• mctormust submit anew affidavit indicating each.
1 am an employer that is.pmyiding:warlters'co ensation � ` and their wo 'comp-policy iniarn,6m.L.
information. Compensation insurance f or nry.employees: Below is the policy and job site
Insurance Company Name: '
Policy 9 or Self-ins. Lie.#:
' Expiration Bate:
Job Site Address:
Attach a copy of the workers' compensation policy declaration page(showings the po Policy number an
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of d expiration date).
fine up to$1,500M and/or one-year imprisonment;as well as civil penalties In the farm of a STOP W criminal penalties of a
Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwardedto
K ORDER and a fine
Investigations of the DIA for insurance coverage verification, the Office of
r Ido hereby certif under the pains and penalties.Qera that the ' ormanoR Prov oho is tFrue
rP j ry
and correct
Si tore; /�
' Date: V
Phone#:
of j`�cial use only. Do not write in Uric area,to be completed by city or town.official
City or Town:
#
Issuing Authority(circle one): Permit/License
I. Board of Health 2. Building Department 3.City/Town Clerk 4
6.Other . Electrical Inspector 5. PlumbingIns
pector
Contact Person:
Phone#•
Information a nd Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the'foregoing engaged in a joint enterprise,and includir-ag 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.ocompliance with the insurance''coverage required."
f re
Additionally, WGL 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)nume(s),address(es)mind 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 requiredto carry workers'compensation insurance. ifan 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
he returned to the city or town that the application for the permit or license is being requested,nottthe Department of
Industrial Accidents Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,pleasccail the Department at the nurmber.listed below. Self-insured companies should entertheir
self-insurance license number on the'appropriate line.
City or Town Officiais
Please be sure that the affidavit is complete and printed legibly. The Department hes 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 appli=t.
Please be sure to fill in the permit/license number which%%-ill 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-cun=t
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 bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, �-
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel.# 617-727-4900 Ext 406 or 1-8.77-MA.SSAFE
Fax 4 617-727-774
Revised 5-26-05 www.mass.gov/dia
t
-50
MASSACHUSETTS UNIFORM APPLICATON FOR PERMUI'TO DO GAS FITTING
(Type or print) Date
NORTH ANDOVER,MASSACHUSETTS
n 11
Building Locations 66 c;0-1Permit# O
Amount$
Owner's Name Moy\Aecra\\�o
New❑ Renovation Replacement Plans Submitted ❑
�a
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w x z d x w A H x
C7 F z F w w C7 p > tz H U
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w > w z Q a Q o o w
x � 3 0 a u x > 9z a H o
SUB-BASEM ENT
B A S E M ENT
IST. FLOOR
s 2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . -FLOOR
(Print or type) ` ,, ` C®one: Certifjrate installing Company
Name (1 L G • -FOS�-u -Bomb IY\2 -}- k'CNnL-{ Corp.
Address 4 WVkV\
Q�MI3 '(d, l%2 Partner.
R—usinessl a ep one1 Firm/Co.
Name of Licensed Plumber or Gas Fitter En C- C. 'CbS�U
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked des,please indicate the type coverage by checking the appropriate box.
Liability insurance policy 12 Other type of indemnity ❑ Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass.General Laws,and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 1:3 Agent
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
3
BY: Signature of Licensed u ber Or Gas Fitter
Title ® Plumber
City/Town Gas Fitter 1 se Number
Master
APPROVED(OFFICE USE ONLY) 0 Journeyman
Date�� .��.<.�1.
"SRT" TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that 1,. . • . . . . . . . . . • • • •
has permission to perform . . . • • • • • • • • • •
plumbing in the buildings of . • ..•G h `.. . . . . . . . . . . • • • • •
at . . (�.�. .5'. �-"' �` �f . • • • • • . ... . . •, North Andover, Mass.
f�
Fee . . .Lic. No..�7�/. . . . . . . . . . ...... .L .�- !1.. . . . . . . . . . . .
PLUMBING INSPECTOR
Check # _ 1
J
82 ► 9
MASSACHUSETTS UNIFORM APPL.IC«TION FOR PERMIT TO DO PLUMBING
City/Town: to&k I\ MA. Date: - Permit#
Building Location: � Owners Name:
66
Type of Occupancy: Commercial Educational Industrial Institutional Residentia
New: Alteration: Renovation: Replacement: Plans Submitted: Yes No
FIXTURES
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SUB BSMT. 1
`BASEMENT i..
,1 FLOOR
FLOOR t}
3 FLOOR
4 1 H FLOOR
5 FLOOR _
-6'FLOOR
7 FLOOR
8 FLOOR
Check One Only Certificate# i
Installing Company Name: Eric C. Foster Plumbing& Heating LLC
Corporation 3092C
Address: 145 Stedman Street City/Town Chelmsford State: MA
Partnership
Business Tel: 978-256-5976 Fax: 978-452-4711
Firm/Company
Name of Licensed Plumber: Eric C. Foster
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ✓ No
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy I/ Other type of indemnity Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hav-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 Owner's Agent
I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the general Laws.
By Type of License:
Title ✓ Plumber Sign ur of iceAed Plumber
Master
City/Town Journeyman License Number: 9311
APPROVED(OFFICE USE ONLY)
FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS)
FEE: $ PERMIT#
APPLICATION FOR PERMIT TO DO PLUMBING
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
SKETCH
PLUMBER
LICENSE NUMBER-
PERMIT GRANTED
UMBER:PERMITGRANTEDDATE:
PLUMBING INSPECTIOR
.*ructural Response, LLC
Sirticnirul E71�7TIeC'1'7!l .�t'T'YTC`t's'
t111'11'.s't!'Uet!(TYtITespoIIse.col IT
CONSTRUCTION CONTROL AFFIDAVIT
IN ACCORDANCE WITH THE MASSACHUSETTS STATE BUILDING CODE 1T" EDITION
FINAL INSPECTION of STRUCTURAL WORK
PROJECT NUMBER: 09086
PROJECT TITLE: Residential Addition and Remodel
PROJECT ',OCATION: 66 Sett-'er' s Ridge Road North Andover, Ma 01845
NATURE OF PROJECT: Engineering Lumber Framing and Wall Bracing
Please find below the "Notarial Acknowledgment" required by the Commonwealth
of Massachusetts. It attests to the authenticity of this document that states Scott
E. Nelson, P.E. has inspected the structural framing for the PROJECT noted above.
The Final Inspection was done by Scott E. Nelson, P.E. on 9, 14, 2009.
THE SCOPE OF WORK REFLECTED IN THIS AFFIDAVIT IS FOR THE STRUCTURAL DESIGN/
CONSTRUCTION OF THE LVL FRAMING AND ASSOCIATED POST SUPPORTS AND FOR THE WALL
BRACING REVIEW.
I, as the Affidavited Structural Engineer of Record (SER) , hereby certify
that I have conducted the structural review of the above stated PROJECT and find
that the framing and bracing has been proper-.y :ns`alled in accordance with the
original structural des_gn calculations, rev-sions ~hereto and the VEdition
Building Code of the Gommonwea-th of Massachusetts and all applicable Codes and is
functioning as intended. All required members and supports have been properly
installed and meet the strength requirements of the design. All bracing is found
to be satisfactory according to the current code and engineering practice.
OF
o
SCOTT[
NELSON
o STRUCTURAL
No 41457
P• N:=% JR:GINA:. -"tA"'RF 'FA' ;i.:E
Notarial Acknow=ed*enWTI)
o
S scribed ana s4 G�%0. is day 20
My Commission Expires 0 It 2-01
��+� OtNce U � �,U'•
U,4t Cf am t�inlUEtt11.� If �I3� Permit No.
Veptutn tm of Puti is f6afttg O=pancy A Fee Checked 4Z
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 peeve blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:04
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
M* or Town of NORTH ANDOVER To the Inspector of.Wires: . .
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant kA- C-6-1 Gq 1)e') 12/Lt 6
Owner's Address C`f� H L,- L-c-4— r- A_)J. tit' J L
Is this Permit in conjunction with a building permit: Yes
(Check Appropriate Box)
Purpose of Buildina Lc-2S ��� 7-1):A41 Utility Authorization No. �7 �2—
Existing Service Amos _J Volts Overhead 11 Undgrnd No. of Meters
New Service 2:�20 Amps Z`•��-, .Vcits Overhead _. Uncipita r
g J�Na, of Meters
Number of Feeders ana Ampacity
Location and Nature of Proposed Electrical Work
1
No. of Lighting Outlets I No. of Hot *%--s f I No, of Transformers Total t "
l KVA
No. of Lighting Fixtures z I Swimming P_oi Above— In- t—
b grna. _ gma. _ Generators KVA
No. of Emergency Lighting,
No. of Recebtacie Outlets b I No. of Oil Burners I Battery Units
No. of Switch Outlets I No. of Gas Surners FIRE ALARMS No. of Zones F
No. of Ranges I No. of Air Ccrc. iotas No. of Detection and t.
tons Initiating,Devices
No. of Oisoosais t I No.of Heat Total Total
Purncs Tons KW No. of Sounding Devices
No. of Self Contained
No. of Dishwashers I Soace/Area Heating KW Ostection/Sounding Devices
No. of Dryers ( Heating Devices KW Local —i Municioai Other
Connection
No. of No. or Low Voltage
No. of Water Heaters KW I Signs Batrasts Wiring
No. Hyaro Massage Tubs ' t I No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements at Massac-users general Laws
I I have a current Liability Insurance Policy including Ccmo;etec rations Coverage or its substantial equivalent. YES
have submitted valid proof of same to the Office. YES O _ -it you nave checked YES. please indicate the type of coverage by
1 checking the aPpproori Ox.
INSURANCE _v BOND OTHER = (Please Scec:h/)
0 o f c/t�� (Expiration Oatet
Estimated Value of E!ectncal worts s S O0C7.
Work to Start to - c1�2 Insoecaon Date Recuestec: Rough G` Final
Signed under the Penalties of perjury:
i
FIRM NAME �`N�t�L- �t-���vt �t J�CCS UC. NO. ✓� �S�
Licensee �. .—..
Signa:ure UC. NO.
Bus. Tel. No.
Address oo i• Q Cf��`- o f 0 3 b Alt. Tel. No.
i OWNER'S INSU ANCE WAIVER: I am aware that the Licensee toes not nave the insurance coverage or its substantial equivalent as re-.
quirea by Massachusetts General taws. and that my signature on :nis permit application waives this requirement. Owner Agent .
1 (Please check onel•
Teteonone No. PERMIT FEE S h
(Signature of Owner or Agenti
� x•%a5ii5
i
Tjg Dat.071.f7......iaORTH
......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SACHUS
I.
This certifies that .... ....... ..............
has permission to perform_,,-
...K;r..... .... ....P...........................
wiring in the building of.................. .............................
at..... Z,:..... . ............. .North Andover,Mass. 4
LC. . ...............................................................
ELECTRICALINSPECTOR
z ga--• o
7
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
.. PERMIT NO. 4
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS PAGE-1
MAP 4-40. f J LOT NO. S y 2 RECORD OF OWNERSHIP (DATE IBOOK iPAGE
ZONE fo n SUB DIV. LOT NO. �-
-���— 1116+- J , Cad ,
• LOCATION s ;"z (J i & /_ - PURPOSE OF BUILDING � ,
OWNER'S NAME t ,•,"" i` V` clo+ �/ `P NO. OF STORIES '� T SIZE 7 /a '
OWNER'S ADDRESS 18 rs-T?l `-C �I G r j BASEMENT OR SLAB P A5 Ate, T G.� o!/ .
ARCHITECT'S NAME J 6 _- SIZE OF FLOOR TIMBERS 1ST��-w0•'vj, , 2/ ND Z,`) 3RD
BUILDER'S NAME .�... wr v SPAN �kj,n v �J.ff _. �, '���— `••,
DISTANCE TO NEAREST BUILDING 7� , DIMENSIONS OF SILLS
DISTANCE FROM STREET ��/ y_7 '
.. .... .. .. . .. POST !/ S C. �✓`Tr
DISTANCE FROM LOT LINES- SIDES �, REAR l/:: io J� GIRDERS 111 �l
AREA OF LOT 2�3 - C r FRONTAGE C�/' / HEirl{T OF FOUNDATION( J GJ THICKNESS
IS BUILDING NEW ` � •]! SIZE OF FOOTING X
" 'IS BUILDING ADDITION fW MATER:AL OF CHIMNEY � L.C..I P�
Y IS BUILDING ALTERATION _ IS BUILDING ON SOLID OR FILLED LAND sem)
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
-• - BOARD OF APPEALS ACTION. IF ANY ,vI / A •IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
" T INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST I Z_oI
SEE BOTH SIDES
EST. BLDG. COST 1-7
PAGE I FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. �C...
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM + 'b 7 S'T
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED B
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS '
•PLANS MUST BE FI ED AND APPROVED BY BUILDly. INSPECTOR `
DATE FIL D • Let-F- _
zv::�;4BUILDING INSPtCTOR
iRVACTUIR-f-OF OWNE AUTHORIZED AGE14T
F E EI OWNER TEL 14fur-
i
PERMIT GRANTEDpp����� J
� PERM'
r .�
i�W .L CONTR.TEL# c1�7" Zd S'.S'
19 U
i�i.�l�7 fDAF ' CONTR.LIC.#
OK ME
MIT ��-
H.I.C.# 1C�7
1
• t
V 6UILDING...REC0RD .
1 OCCUPANCY
12'
SINGLE FAMILY- �_ sFoRlEs
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM"'k.,
MULTIFAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF 'BUILDINGS. WITH PORCHES. ;GA- _
APARTMENTS RAGES, ETC. SUF,ERINIPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
`=2 FOUNDATION" 8 INTERIOR FINISH
CONCRETE - 3 1 2 13
CONCRETE B ' PINE
BRICK OR-.S7ON HARDW'D
PIERS __-_ PLASTER ... ..-
--. DRY WALL .. -
• ,. .. ' .3 BASEMENT
AREA FULL 19,011 FIN. B'M'T' AREA
FIN. ATTIC AREA
NO 8 M FIRE PLACES `•'
... ,....1... ,. _ . ... •
" HExD ROOM _ MODERN KITCHEN ��_ � t •„
_• ,4 WALLS I 9 FLOORS „
I' CLAPBOARDS B 1 22 f 3
DROP SIDING CONCRETE I_
WOOD SHINGLES EARTH '-
ASPHALT SIDING HARDW-D - -
m ASBESTOS SIDING. COMMON
VERT. SIDING ASPH. TILE
T STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK M N Y ATTIC STRS. 3 FLOOR _ •"'
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING -
STONE'ON FRAMESUPERIOR _
11 ADEQUATE h1 NONE
5 ROOF 11 10 PLUMBING ^k •.,.,
GABLE HIP BATH 13 FIX.)
GAMBREL MANSARD TOILET RM. 12 FIX.) J -
FLAT SHED WATER CLOSET
ASPHALT SHINGLES je LAVATORY _
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
I
TAR 6 GRAVEL - STALL SHOWER t
ROLL ROOFING MODERN FIXTURES i
TILE FLOOR Y
TILE DADO
6 FRAMING 11 HEATING
_ WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN. r "
TIMBE M 3 COLS. STEAM
_ STEEL BMS. &rOLV HOT W'T-R OR VAPOR
WOOD RAFTERS AIR CONDITIONING "
RADIANT H'T'G ;
UNIT HEATERS
y NO. OF ROOMS GAS
OIL fd r
e
B.M.T 2nd ELECTRIC -
1st L•f 13rd I NO HEATING ' .`
.r
F �10RT�y
Tov of,
e
Aindover
No. 440 to
3
dower, Mass., 19
'9 COCNIC HE WICK i�'�• .
r E D
v BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
THIS CERTIFIES THAT. BUILDING INSPECTOR
i'�--k-A...........�,. '..1..�n.1 ............D.e.V,..............................................
/ Foundation
has permission to erect........................................ buildings on ....GP.�,p.........S.F Rough
to be occupied as ................................. �.1J..6.. ................ (../r��
................................................ Chimney
provided that the person accepting this permit shall in every respect conform to th s of the application on file in
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final
Buildings in the Town of North Andover.
VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTORRough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION ST TIS ELECTRICAL INSPECTOR
Rough
................................. ........... . .............
l BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a conspicuous Place on the Premises — Do Not Remove Rough
No Lathing or Dry Wall To Be Done Final
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT
[Burner:
Street No.
Smoke Det.
7/j
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that allnecessaryapprovals/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: Q� Le� l Phone b��'�i�i��
LOCATION: Assessor';s _ Map Number Parcel
Subdivision Lot (s)
Street Q `\+ St. Number ,
Use Only************************
RECO DATI O OF O GENTS:
Date Approved
12111
ConserMa ion Admini rator Date Rejected
Comments
ITIT
Date Approved
Town Planner Date Rejected
Comment
Date Approved
Health Agent Date Rejected
Comments
Public Works. - sewer/water connections `�-fJ L") ?
- driveway permit �-7
Fire D'e artmennt W_(14101,4A,
Received by Building Inspector Date
i
SLTTLPkS
PR4?,A17 -E FLAN
Tara Leigh. Development Corp.
185" Hickory Rill.Rd.
N. Andover, MA 01845
236 _
LOT 7
291,►fo5 5. —
F'"" _
36 24
22�
Z _ 36
Z
02 SIT'Tl.MS S. H. `9+00
8+00 RlDC7 S -
4�_
H
AD
°w
V' �10RT
Town o , - - over
No. 440 to
* z dover, M.Iss.'_ _19? 7
o . LAKE
'9 COC NI C ME WICKA TED
V
E BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
THIS CERTIFIES THAT.................. / -. ........... .VP.H............ ..4F.0,.............................................. BUILDING INSPECTOR
6..
KP
p� Foundation
has permission to erect........................................ buildings on ....C�.SP.........5. ......../fit Rough
tobe occupied as.................................7/74/..x..6.. 15............... .. ..................................................... Chimney
provided that the person accepting this permit shall in every respect conform to th arms of the application on file in
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION
Z
TS Rough
.............................. .................. ... 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
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT
Burner
Ga Eck Street No.
1 Smoke Det.
CERTIFIED PLOT PLAN
LOCATED IN NORTH ANDOVER, MASS.
SCALE.1"=40' DATE:9112W
Scott L. Giles R.P.L.S.
50 Deer Meadow Road
North Andover, Mass.
RpP�
R
RS
10 Ge r
G ,
+
1� 22 2a p+!-
m
q No 'C C7
1.
ISS'N a—a O
N_
Z M
NO
N Lo 65 S,F
ZQ,1 Ncp-
c
,� 0 N1,0 N R / /
C g�FF�
X24 p0
r
I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE
THE OFFSETS tH Ci
OF THE BUILDING INSPECTOR ONLY
SHOWN COMPLY 8 T
AND SUCH USE IS FOR THE
WITH THE ZONING '^
DETERMINATION OF ZONINGBYLAWSOF
NORTH ANDOVER CONFORMITY OR NON-CONFORMITY �, FCtSTfa�
WHEN BUILT WHEN CONSTRUCTED. <<��
MASSACHUSETTS UNIFORM APPLICATION,.FOR PERMIT;-TO:DO°PLUNjS1,gG
(Type or Print) ;
NORTH ANDOVER ,Mass. Date:Ah 6 ��� 4
Building Location f2�e( '3j Permit IIV%W1!191 a"r;A
Owners Nam I Ve'vcL ,�i�
New Renovation Replacement [J Plans Sybmitted
FIXTURES
_ 0 '.
z
N O O Z ~
1— to
w Y tt• a v h N a n ¢ a .
N Z CI Q ¢ __ O
O W Cl Q al W z
va.
¢ o Z°' trZi w >- Q H h z o a w a a aleo w
¢ w O W Q a) o Q t» cc a x a a Cl66 a
w x d X u O X X. Y Q O 1•- Q 3d j W tL X W
•.` f, V F' O Z 0. 7 N I' Z O p as x _i W O V
t"
Y Z
Q ~ > Q X N N 4 0 0 0 J Q Q ¢ tiC aG Q O Q I-
3 to U. a a Q a to Q
I4
SUB-,BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
31113 FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
t
(Print or Type) Check one: Certificate
Installing Company Name Rpy2•tl�� �( �� 4`lrr Corp. -
Address•� �,� C.4("V �ecf Partner.
Firm/Co.
Business Telephone /°(j6 3 3 'a 29cg ff
Name of Licensed Plumber: 4jj )gj ct' e. I�� r�!✓2. ___
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy 211oother type of indemnity [:] Bond 0
Insurance Waiver: I, the undersigned, have been made aware- that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of ownerlagent of property Owner Agent`s
' I I helebr cetlify that all of dee dclails and infotmalion I Marc subiniticd(of enlucd)in atmsvc sppliation dee Ituc at`d� salc to We beat al ttly
knowledge load that all plumbing work and installations Irctfnmecd undct retnut iesucd fat this application will be in taupWnoe with all Valitwttl path•
orlsiam of the Massachusetts Stale Plumbing Code and awples 142 of the(:cnual Lawn- ,
By
Title Signature of Licensed Plumber
Tvie; of Plumbing License
City/Town: /,f St-�/
License Number L� Mastsr [] Journeyman
_ �T Dat6. . . . . . . . . .
3503
f gORTIy,
3?;,<��•°;•.,"ooL TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
,SSACMUS��
This certifies that . . . . . . . . . . . . . . . . . . . . . . . .
has permission to perfortn—.-n?!- s.!-�. '.-<+,! t,
1
plumbing in the buildings of�:� . . . . . .
at. .e ofth Andover, Mass.<>
F ,f. Lic. No!�`5:#fl. . . `.. . . . . . .
PLUMBING INSPECTOR
'/0
WHITE:
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
NORTH ANDOVER,
Maas. Dale-_ _� b _19 17` M
Building
Location lie Ve Permit #1 �S
Owner's /
Name �1 ���'
• New (� Renovation 0 Replacemen{ ❑ plana Submitted:ed. Yeti �] No p
M >t
W W t Olie
t1 h
d lie _r „ lu u b 1- = x M
< O K Oz O h
wIC
aL al = V r Ic
N Is11W 0 H A O >
Z < O 0. la, o 0 0 > i
QUA—saMT. O
• •AtIgMANT
IST FLOOR
!NO FLOOR
l
SADFLOOR `
'
4TH FLOOR
•TH FLOOR
STH FLOOR a
ITH FLOOR
1
a1TH FLOOR
Installing Company NameCheck one: Certificate
Address Corp.
e�d-1(-) d Partnershlp
Business Telephone L6,3 3ZZ 79a O Firm/Co.
Name of Ucensed Plumber or Gas Fitter /tea
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent. Yesc[I one
f H YOU have checked, e, please Indicate the type coverage by checking the appropriate No
A liability Insurance policy OJ"�
Other type of Indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have ere u
Chapter 112 of the Mass. General hews, and that the Insurance covers my signature on this g required by
Permit application waives this requirement.
Check one:
%no ure o Owner or Owners Agent Owner 0 Agent O
I Hereby cattily that aq of the details and Information I have submitted(or entered)in above application are true•
knowledge and that eN plumbing work and Installations performed under the permH Is for li a llon at n velli d accurate ooto the
hebest of my
tMnt provisions of 1 •Massachusetts Slate Des Code and Ctrapler 112 0l the with aq
� Laws.
TYPS41 Lkense:
This lFrPlumber
stiller 9 ure o nae um er or as of
Gty/Town Master License Number
. lJoumeymen
NTF10NED(OFFICE USE ONLY
M /
J Dat . . ....... ..� . ... ..
NpRT►, TOWN OF NORTH ANDOVER
�? �• pA PERMIT FOR GAS INSTALLATION
SSACMUSES
. f C
This certifies that.- . . . . . . . . . . . . . . . . . . . . . . . .
has permission forgas installation .l.fi .
in the buildings of .�t'.r• . :.,r:�:-�• . . . . . . . . . . .�.
at . .�. . . : .� . : �. . :f f.-�^U ..r . . ., North Andover, Maw.
Fee//.,'. .r A) . Lic. No.,,:-t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer