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Miscellaneous - 67 SETTLERS RIDGE ROAD 4/30/2018
67 SETTLERS RIDGE ROAD 210/061.0-0107-0000.0 r 1 ® MAPFRE The Commerce Insurance Companys'''' Citation Insurance Company"' Commerce " Gore Road,Webster,Massachusetts 01570 INSURANCE- 508.949.15001 www.commerceinsurance.com February 09, 2015 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our insured: DAVID M TORRISI/SARAH E LAIoTNING Property Address: 67 SETTLERS RIDGE RD Policyk HXV613 Date of Loss: 02/09/2015 Filek JWPK45-HNJYH5 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. SUSAN JOHNDROW Telephone: (508)949-1500 Ext: 15193 Sr Claim Representative,Property Toll Free: 1-800-221-1605,Ext:15193 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. February 09, 2015 CIC 254 (Rev.4/95) MAIL 506 The Commonwealth of Massachusetts Office Use Only Department of Fire Services Permit# g BOARD OF FIRE PREVENTION REGULATIONS Occupancy&Fee Checked c� Rev. 1/07 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code(MEC), 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: August 10,2009 City or Town of No.Andover,MA 01845-1118 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) 67 Settlers Ridge Road Owner or Tenant David&Sarah Torrisi Tel.No. 978-682-5644 Owner's Address Same Is this permit in conjunction with a building permit: Yes [---] No F--] (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Undgrd =No.of Meters New Service Amps Volts Overhead Undgrd =No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Kitchen Remodel, , 7ble may be waived by the Inspector of Wires. D I.of Transformers Date.............�•�•.:....9....... merators of Emergency Lighting Battery Units IAN(1,RTM °'.•�•°;•'"o TOWN OF NORTH ANDOVER :E ALARMS #of zones 3i •`- _ °c of Detection ° ; p PERMIT FOR WIRING of Alerting x of Self Contained �S al Municipal F Other F SACMUS ............................. 1 This certifies that ./ ) .................... :phone Devices 1 .............. has permission to perform ...:::.-. .: �� '` '«••••••••.. •• or as required by the Inspector of Wires. wiring in the building of....�..,.... ,�.••• ••••••• ' . -r- ... -... . North Andover,Mass. ipal policy.) at.�..? EC Rule 10,and upon completion. Fee..Y.� Lic.No. . /.7� ILECTRICAL•••• •• a of electrical work may issue •••••"""""" NSPECTOR Y ttion" coverage or its substantial Check /1 ?_n S-- ed proof of the same to the permit 890 perjury,that the information on this application is true&complete. FIRM NAME Dumais Electric LIC.NO. 12170A Licensee Mark A.Dumais Signature —J",67, LIC.NO. 26665E (If applicable, enter "exempt"in the license number line) Address 8 Newport Street Bus. Tel.No. 978-683-9438 Methuen,MA 01844 Alt. Tel No. 978-685-4553 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: LIC.NO. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage normally required by law.By my signature below,I herby waive this requirement.I am the(check one) r—owner owner's agent Owner/Agent Signature Telephone No. PERMIT FEE: �' �� �z �f�z^� � �� �u���� ��i���o/�.� l r � � � Date.C� . . . . . . . . <. "°RTM TOWN F NORTH ANDOVER PERMIT'FOR PLUMBING ,SSACHUS� m - This certifies that . . . .!. ! . . . . . . . . . D���'`�` . . . . . . . . . . . . . . . has permission to performZ. plumbing in the buildings of . . . . .x41. . . . . . . . . . . . . . . . . . . . . . at . .�. 7 J Thr � f e'O? ... . . . . . . .. North Andover, Mass. Fee`-/j' O. .Lic. No.. J0.T j'7 . . . . . . . . . . . . . . . . . . . . . . . . . . /?_1 PLUMBING INSPECTOR Check # 9V 8'164 t" MASSACHUSETTS UNW0RM APPLICA"MN FOR PERMIT TO DO GAS (Type or print) ZINC NORTH ANDOVER, MASSACHUSETTS Date Building Legationseff-0.1tY �Ao Owner's Name Amount S New _ Renovationor Replacement ' rid' plus Submitted VVV ❑ � W o,. a z z c O U w O m Z O 4 C W F e RW a z C a 0 z �' w SUB -BASZ EM ENT S C O C a 0 BASEMENT ] ST. FLOUR 2ND , FLOOR 3R D . FLOOR 4TH . FLOOR TH . FLOOR 6TH . FLOOR 7TH . FLOOR. 8TH .' FLOOR. (Print or type) n Name Check one; Certificate Installing Com an Address r� �� /� Corp. P Y ��� us ness Teiep one , Partner. n Name of Licensed Plumber'or Gas Fitter /� f.,.� FimYCo. INSURANCE COVERAGE I have a current liability insurance,policy or it's substantial equivalent Check one- If you have checkedy_es,please in a the type coverage by checking the appropriate bo[3No� Liability insurance policy Other type of indemnity D Bond 13 Owner's Insurance Waiver 1 am aware that the licensee does ndoes n--"� a�e the Insurance coy Mass. General Laws,and that my signature on this.permit application waives this re4ucover rtge required by Chapter 142 of the Signature Of Owner or Owner's Agent Check one: I hereby certify.that all of the details and information I have submitted(or entered)in 0 Agent D best of my knowledge and that all plumbing work and installations performed under Permit compliance with all pertinent provisions of the Massachusetts S are true and accurate to the GaV Co a and Ch Issued for this application will be in Chapter.l 42 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Plumber City/Town, Gas Fitter , ,nSe mum er aster APPROV Title ED(oFina usE ONLY) Journeyman ..r' j i �, � --�-=•...;,�.,�,=Qcrn OJ M2csachuse>.ta' Department of IndMtriat Accidents ice I atm MfM l' 6-00 w \" ¢sFiineQton Street Irb BostoeL, MA 0.2111 Warkere Colmpensafian Insurance A iicant Information AFic�avit: dui,iders/ContractorslElectriciaQs/pi�ber s 11I1e (Business/Or Please Print Le6ibiy €an iza#i o Nin di v i d uai); Address: City/Statezig: Phone# Are you an employer?Check the appropriate box: 1.❑ I an a employer with em to -- -- -- 4 ❑ I am a�eneml con Type of project(required): p Y .s(full and/ part-time).* h2. ave hire tr-actor and I ) ❑ 1 am a soler d the sub- .o• ❑ New proprietor or partner_ listed sub-contractors Construction ship and have no employees °� the attached sheet z 7• ❑ Remodeling. working for mein any capacity hike sub-contractors have NO workers' comp. insurance 5 mss' comp. insurance. g' ❑ Demolition required.] ❑ We are.a corporation and it 9' ❑ Building addition 3.❑ I am a homeowner doing all work rif5c� have exercised.their� 10: ,ht of e ❑Elect"Cal repairs or additions . Myself[No.workers' xemption per MGL 11.❑ Plumbing insurance required.] t O0iT1P c. 1$2, § 1(4) and we.have no -repairs or additions eniplOYees, [No workers' 12'❑ Roof repairs `Am'aPpficant.that checks box#l.mast also fiii out the section belcDMow onurance regUjred] 13.7 Qt}1ef 'iiomcownerE whu submit•fliis a,"Idavir indreatit�g 1hej+atc.;uirg tic} a- 1Convactars Ilial Chec1: €their work'.Compensation o1i this box mein attai;i:ed an "f'L(hen hire e P �'information. additional sheet showing utacae Cwnirueiurs mus(submii a nm i�an mplay th, 1e a of Mctots a tS pPovidirlg wotfSe S'con-'sensat on t. st:b Cc;, and their workers,comp. oii�iniomIalion. ,� matia2 uzsrPance for n9'emPlo�'ees Belo►r� ' Insurance Company Name: eP°hc3'andjob site Policy#or Self.ins. Lic.#: Job-Sit~Address: Expiraiion Data: Attach s Copy of the workers, compensation policy deela City/st twzip: Failure to secure coverage as required under Section 25A o M ion page(showirog the policy fine up to $1,500.00 and/or one im P P c'number and expiration date}. MGL c. 152 can lead to the imposition of Of u to.S� a. prisanm„nt as well as civil penalties in the form of a STOP WORK criminal penalt7es of a Investigations0 of.the D A for insurance c�overa advised a eo ' py of this statement ma be RDER and a fine g anon, ) fo�arded ib the `Office of Ido herebj,certifj,under the pains and penalties Sisrtature: opejurfthf � � e inf O1maion provided above is true and correct Phone#: Date: Oficial use onip. Do not write in this urea, be cornpieted h 3 cAY nr to wrr offccitr( City or Tows: Issuirte Authorit3,(circle one): Permit/License# 1. Board of Health 2. Buiiciing Department 3. City/Towx Cferk 4. Electrical Inspector S. Piumbinu b Inspector Contact Person: Phone#� LL V1 L14L1VU i=&j u j ist ucrionS �.. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their=ployees. Pursuant to this statute,an en7ployee is defined.as"..evt -y 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 amity,or any two or more of the foregoing engaged in a joint enterprise,and incluri-i-ng the legal representatives of a deceased employer,orthe receiver or trustee of an individual,partnership,associati on or other legal entity,employing employees. However the owner of a dwelling house having not more than.three ap,artments and who resides therein, or the occupant of the dwelling house of another who employs persons to do inn int.-nance,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 bean employer." MGL chapter 151 §25C(6)also states that"every state tie-r local licensing agency shall withhold the issuance or renewal of a ii=se or permit to operate a basins 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 worl< tm til acceptable evidence of compliance with the insurance requirements of-this chapter have been presented to the r-<�ntracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es) amd phone number(s)along with their cerificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees othertiran the members or.partners,are not required to carry.workers'compensation insurance. If an LLC or LLP does have-. employers, a policy is required. Be.advised that this afficLa.vit may 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 Dopar tinent of Industrial Accidents. Should you have any questions mmv_rdiro the-lata,oT if you are mquirrd to obtain a workers' compensation policy,please call the Department at the nammber.list_ below. Self insured compa;iies 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 Ier=ibiy. The Department has provided a space at the bottom of the affidavit foryou to fill but in the.event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permMicarrse number which will be used as a reference number. In addm'on, an applicant that must submit multiple pesmit/liccrise applications in arty given year,need.only submit one affidavit indicating current policy information(if necessary)and under"Job Site Adciress"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially sta rnped 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. When: a home owner or cifiizen is obtaining a licens: or permit not related to any business or commercial venture (i.e. a.dog license or permit to burnleaves 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 Dpwtn-_nt's address,telephone and fax number. The Commonwealth of Massachusetts Department ofLmdustrial Accidents. Office of Elavestigations 640 Washt_i gton Street BnSM MA 62111 Tel. 4 617-727-45100 M=406 fir 1-877 MASSAF'E Revised 5-26=45 FaX#617-7-7-7749 VJUmzLass.gov/dia Date. pRTly � � TO fWN OF-NORTH ANDOVER PERMIT FOR PLUMBING SA US /J� This certifies that . . . . .! ".`. . G/� .4-�! �/� �/. . . . . . . . . . . . . . . has permission to perform . . . . !. . . . . .iG. . . . . . . . . . . plumbing in the buildings of . . .�W.C.rJ. .uSx. . . . . . . . . . ... . . . . . at .b 7 ! TJz X115 !Cff' . . . . . . . . . . .. North Andover, Mass. Fee. Lic. No../o.p�7 . . . . . . . . . . . . . . . . . . . . . . . . . . . PIP PLUMBING INSPECTOR Check ff 8 '165 (r r' I' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS "�(1I,r� n /1 Building Location !�1 S��/ /��Owf hers Name A/014 Permit# 7 /C���� Type of Occupancy Amount S//�l�/. Y New Renovation Replacement Plans Submitted Yes No FIXTURES � a c w wcc cc w \ ow w z a z a A a F a L7 RB•BM BASEVINf MHOOR M H-OCR 3M>TDM 4MHOCIR S H-a R r s>H 11fM - 7MIr" M>rrDM (Print or type) nACheck one: Certificate Installing Company Name /// Corp. Address ��"/ -3-� Partner. Ahl Cv7— D 6 Business Telephone 74_ Firm/Co. Name of Licensed Plumber: / O Insurance Coverage: Indicate the t, e of insurance coverage by checking theappropriate box: Liability insurance policy Other type of indemnity F, Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Ma /chuse S tubing Code and Chapter 142 of the General Laws. By: ignature 51 i7censeuum er Ty e of Plumbing License Title City/ icen e um er Master Journeyman ❑ APPROVED(OFFICE USE ONLY tR ' The Commonwealth of Massachusetts Department Of Industrial Accidents t ` Office o .J�' f Invests,ations 600 Nrashin.Mm Street Boston, M4. 02111 cz Workers' Cwww nmsgov/dia . ompensation Insurance Affidavit: Bulders/Contractors/Electricians�pA licant Information lumbers Please Print LeQ'bl NaD a (Business/prganiza ion/fndividual): Address: Citysbde/Zig: Phone#: . Are you an employer?Check the appropriate.box: - I•❑ I am a employer with 4. ❑ I am a Type°f P�I�(regairet[): employees(full and/or * general contractor and I part-time). have Fired the sub-aonbartors 6• ❑New constrttctio: 2•❑ I am.e sole proprietor or partner- listed on the attached sheet i 7• ship and have no em to ees ❑Remodeling P Y These sins-contractors have working for me in any capacity, workers, comp.insurance. 8. Q Demolition [No workers'comp.insurance 5. ❑ We are: a corporation and its 9. Building addition 3•❑ required-) officers have exercised their 10.El Electrical repairs i am s homeowner doing all work right of exemption per MOL 11. m additions myself.[No•workin,comp, c. 152, §1(4),and we have no Plumbing repairs or additions insurance required,].t employees. ['No workers' 12.[3 Roof repairs comp. insurance required.] 1 M7 Other 'My appiicattt that shake boz't�l must also fill out the section below shovuing their workers'compensatia;policy iaformefion t mftftaeth who submit this affidavit indicating they ars doing all work and then hie outside contractats Contractors that check this box mustatteeh (an addhioasl shear showir t he name of the sub-ca must submit a new affidavit indi 1D er fhat °�'�and their work= con;.. such I alit e r Poll",ir£omiatian. Y u pmr'grmg'"arkers'compensation insurance for nr en plgpem Below is the o ' L. infarrnation. p lccl'and job sitr . Insurance Company Name: Policy#or Self-ins. Lic.#: • Expiration Date: Job Site Address: City/State/Zip; Attach a copy of the workers' compensation policy declaration page(showing the poficy number and expimtio Failure to secure coverage as required under Section 25A of MGL e. 152 can l °da }, fine up to$1,500.00 and/or one-year imprisonment,as well M civil penalties in the form oead to the imposition of criminalPenalties of a f a STOP WORK Of up to$250.00 a day against the violator. Be advised that a copy of this statement may f forwarded to the ORDER and a fine Investigations of the DIA for insurance coverage verification. Office of I do hereby certify under the pains and penalties of perjury that the informationp vtro ' ded above is true and carred Si tune: Date: Phone#: Offtcia!use only. Do not write in this area m be completed by city or town offlad City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2. Building Department 3.City/Tovvn Clerk 4. Electrical Inspector S.Plumbing fmpector 6.Other Contact Person: Phone#: Information a nd Instructions y 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 Mon of the'f6mgoing engaged in a joint enterprise,and includirig 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 apa r tments 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 152,525C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evideucezJ7 compliance with the insumnce'coverage required" Additionally, mGL chapter I52,§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-confractor(s)name(s),address(es).grid phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not re luired 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 Depmtnent at the numberlisted below. Self ir-swred conripRRir•c ehnLId a^.r"'!h^'„ self-insurance-license number on the'appmpriate line. City or Town Officials 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=nt Please be sure to fill in the permit/license number which will be used as a reference number. in addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicatingcurrent policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy ofthe 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 affidaviL 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 as a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Departmcnt of Industrial Accidents Office of Lnvestinstions 600 Washington Street Boston, MA 02111 TeL#617-727-4900 ext 406 or 1-8.77-MASSAF'B Fax#617-727-7744 Revised 5-26-05 www.mass.gov/dia Aug 17 09 12,20p Cote and Foster Cont 978 6821221 p.2 nuo I - coon HAN] Uan L, W I W I N•t•918 465.516D Ido 3629 pap 96 Dan L Gelinas From: Dan L Gelinas(danlgelinasCumcast.netl Sent: Monday,August 17,2009 7:69 AM To: Steve Cote, Subject. B AFFIDAVIT LVL header 67 Settler Ridge Tonissi framing only ISA ISA 09103.doc Attachments:A Header 67 Settlers Ridge H Andover.pdf;B Affidavit LVL header 09103.pdf FAXED Bill, Attached B AFFIDAVIT LVL header 67 Settler Ridge_- Torrissi framing Thanks, Dan LG Gelinas 5trudval �nglrleerlrtq L..0 Daniel L. Gelinas,P.E. 579A North End Blvd. Salisbury,MA 01952-1738 email danlbelinasnc .net Fax cine 978.465.5160 Phone 978.465.6436 Cell 978.360.2562 Note:aol acoount dropped 8/17/2009 Avq 17 09 12:20p Cote and Foster Cont 978 6821221 p.4 Au8 .17. 2009 7:56AM h n.L. Gelin3s, P t 918.465.5160 h1a.a6i9 Double 1-31411 x 7-114"VERSA•!-AMO 2.0 3100 SP Floor BeamlHeader side wall BC CALCi9 2.0 Design Report-US 1 span 1 No cantilevers l 0112 slope Build 275 Thursday,AuguM 13,2009 13:40 .fob Name: File Name, A 8C,9CC Address: 67 Sttlers Ridge Desall)bon'Header side wap City,State,Zip:North Andover,MA Spamter. Dan L.Gelinas,PE Customer. D"Vner. Getinas Structural Engineering LLC Code reports: ESR-1040 Company: PSA North End Blvd.,Salisbury,AAA 01552-1738 phone 878.485,6436 (Fax 5160) NNW=" 130,3112' ill-Caao LL 875 Ibb DL 1,285 lbs LL 875 IaK SI 11911 bb DL 1,285 Ib$ SL 1,911 Iba Total Horizontal Pro dud Length=07-00.00 Load Summary Llw Dead snow T besari ion Load not, Start End Wind RaMliva 1 roof 100X gOK 11576 111K 126% Trlb. Un1.Area(pttf) Left 00.00-00 07.00-00 10 39 2 attic Unf.Area(P4 Left 00-00-00 07-00-00 30 10 14-00-00 3 2nd floor Unt.Area(psQ Left 00-00-00 07-00-00 40 10 07-00-00 4 wall Unf.Area(psi Left DO-00.00 01.00-00 0 10 01-00-00 14-00-00 Controls Summary value %Anowebla Ou►aUon Caso_ Span Poo Moment 222 ft-lbs o,ccc r<aus 134.691° 115gb 13 1 -Internal End Sheat 3,029 lbs 54.5°!° 115% Com0letena&s and accuracy of lopul rnuat Total Load Deft. U384(0.216") 65.9% 2 1 -Left be W as vi ence of who would rely on Live Load Deft. 053,2(0.148' 67.7°b 2 1 �u aiavktence of auttabilgy for Max Den. 2 1 0 le awkvtion.Output here based Span l Depth 0216•• 21.6% 2 1 on building code aceeptod design n/a 1 PMPAMea and analysis methods. Inelallatim of BOISE snglnoered wood produga mu"bs m acccrdaocawAh BgtinalSuyioa is obn. Lxw %Allr %Anew currantkgtallatlOnGuide and applimbie j �_ Value Support Member matorw building code&.To obtain Installation Guide 60 Post 3-112"x 3.112" 4,071 ibs Ns 38.5% UnspecWed °r ask questions.Olease call B1 Post 3-112"x 3-112" 4.0711bs Na 38.59x° Unspeelfted 01411Z32.0788 before n&Itrlletion. NOdee BC CALCO,9C FRAMER*BOAi,A,IS*", Design meets Code minimum(L240)Total load deflection criteria. BOI EI13LU� M RIM SIMPLE FR BCH BOISE GLUL/1M1° SIr1APLE FRAMING Design meets Code minimum(U360)Live load deflection,criteria. SYSTEMO.VERSA-LAMS.VERSA-RIM Design.meets arbitrary(V y Maxfmum load deflection criteria. PLUS/D,VERSA-RIM®, VERSASTRAND&VERSA.Mro re U �L%VAV!s UadernarM&of Brise Wood Products, f:a t_L.C. quired,three provided , onnection Diagram e a t � OF DANIEL L. • (3ELlNAS STRUCTURAL No. a minimum=2- c=3-iw, b minimum a 3" d=12' AAember has no aide ioexls. Connectors are:16d Common Nails Page IofI z rDate...............................—2 .. 5 t ,&ORTM 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING i o �,• cHus�� This certifies that ....... „C;. . V..... .......!.. .,�............................ has permission to perform C .................... ................. wiring in the building of....f 1 I M Cq Sy/ _- at.......�.. ..`�1 /F/t, .........�ll;F............... .North Andover,Mass. Fee... s.© ... Lic.No..._- .7,'?-'00............ .. ELECTRICAL INSPECTOR J , Check3� �3� a ` N Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. �� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked T [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3-17-2006 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&.Number) 67Settlers Ridge Owner or Tenant Mary Casha Telephone No. 978-314-8941 Owner's Address Same Is this permit in conjunction with a building permit? Yes No X (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace 3 fitures&other misc items for sale of home. Completion o the following table may be waived by the Inspector of Wires. No.of Recessed Fixtures 2 No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA y No.of Lighting Outlets 2 No.of Hot Tubs Generators KVA No.of Lighting Fixtures 2 Swimming Pool Above ❑ In- 1:1o.o Emergency ig mg rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches 4 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pum Nu%ber Tons KW No.of Self-Contained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent �- OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) On File Feb/2007 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 3-16-2005 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: t LIC.NO.: Licensee: Kelly M.Casey Signature LIC.NO.: 37200 (If applicable, enter "exempt"in the license number line) Bus.Tel.No.: 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabi ity 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: $25.00 //- Date. . . . . . .. . . . . ... .. NORTH Of „ao ,°.1ti0 3= �` TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION �9SSACHU5Etty This certifies that . . . . . . . . . . .. . .`. . - . . . . .. . ... . . . . . . . . . . . . . . . has permission for gas installation . . . . ... . . . . .{.... . . . . . . . . . . . . in the buildings of . . . . . . . . . . . at . . . . . �:=!'�. . . .� G' � •North Andover, Mass. Fee-,V.4 . �. . . Lic. No. 3.7. .. . . . . . . . . . 1 GAS INSPECTOR Check# / j 451 oz) MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING _ (Print/or Type) r _ �/ , An d Mass. Date�+ � 1�"l� Perm # of Building Location .SZ.-h1lL is A -Owner's Name ��,cS f iY P�D��L ��✓ Type of Occupancy New p Renovation [a, Replacement p Plans Submitted: Yesp No M--1- n Y = rt A rn v c c s H a H o 0 _ Q z W F y O u ~ < _ Z C O z OK O N F- y W ¢O =is c ■ < to C V W = W Z < 0 0 1u V z fs z 0 ~ W Q M S cc '= o n x U. $: e O J o e: 9 SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET IX Corporation 103C MIDDLETON, MA 01949 C Partnership Business Telephone 978-774—' 2760 [, Frm/Co. Name of Licensed Plumber or.Gas Fitter WILLIAM R. HARRIS INSURANCE COVERAGE: have a current liability Insurance policy or its substantial equivalent which me--+s the requirements of MGL Ch. 142. + Yes 13 No O If you have.checked yes, please Indicate the type coverage by checking the appropriate box A liability Insurance policy 0 Other type of indemnity C1 Bond 0 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: Owner J Agent p Signature of Owner or Owners Agent I hereby certify that all of the details and information I have submitted for entered)in above app+caticn ate true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this vnii be to compljroe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the QOSWall Laws. gy Tof License: Plumber Ng-nature of Plumber or dter Title Gasfitter Baster License Number 3785 City/Town Plumber APhXNEff NL �r I Location ' --� -Yli� c� No. lDate NORTH TOWN OF NORTH ANDOVER 9 i » + ; . Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ ` s�CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 7 � r 171-1176Building Inspe t TOWN OF NORTH ANDOVER BUILDING DEPARTMENT "BUJELLDING TO CONSTRUCT REPAT RENOVAT OR DEIIIOLISII A ONiE.OR TWO FAMILY DWELLING. .i ERMIT NUMI3ER: DATE ISSUED: _ R �� tS71� s SIGNATURE: arae Building Conin.ussioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION 111..1 Property Address:: r 1.2 Assessors Map and Parcel Number: C W? �1�� Vb 1 l Map Number Parcel Numbbr 1.3 Zoning information: 1.4 Property Dimensions: Zonin District pr. orad Use Lot Area Frontage ft' 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Pxxfuired Provided Re quirred Provided 1.7 Water Su"IylviG.L.C.40. 54) 1.5. Flood Zone Information: IT Sewerage Disposal System: Public Q Private 0 Zone Outside Flood Zone 0 muaicipal 0 On Site Disposal System. 0 _JI SECTION 2-.PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 24 Owner of Record h -7 _11146�z (2 Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: T�. 1„ Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: I License Number 7,11 um -� Address i v0 Z2 6!2` 't� � I Expiration Date re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 v Company Name Registration Number r. �w '1T /�✓c , i'1 Address r 4 7J0 Expiration Date ^ re Telephone �J I SECTION 4-WpRKERS COMPENSATION (rLG.L C 152 s 25c(6) Workers Compensation Insurance affidavit must tie completed and sub'initted:with.t}iis:application. Failuie to provide this affidavit w' in the denial of the issuance of the buildin rmit. SII result ' Si ned affidavit Attached Yes....... No.......17 SECTION 5 Descri tion Of Pro osed Work checkall a Ucable New Construction 0 Existing Building 0 Repair(s) (J Alterations(s)s Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: a S:. CY AJ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Building Com leted b ermit a licant = 1. _ (a) Building Permit Fee 2 Electrical ^2 Multi lier (b) Estimated Total Cost of 3 Pluittbin Construction 4 Mechanical HVAC Building Permit fee(a) x.(b) 5 Fire Protection 2-ZD 6 Total . l+2+3+4.+5 SECTION 7a OWNER AUTHORXZATION TO BE COMPLETED`WHENber OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT f f, 'Iereby authorize as Owner/Authorized Agent of subject property efy behalf,in all matters relative to work authorized by this building permit application, to act on i nature of Owner ECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date dL-1 JJ {, °Pent aAuthorized Agent of subject belief,declare that the statements and in on the foregoing application are true and accurate, to the best of my knowledge d bel kF gire e .1�r/Aggent i Date OF STORIES SEIv1ENT OR SLAB SIZE E OF FLOOR TIMBERS I 2 LN 3xv' IENSIONS OF SILLS LENSIONS OF POSTS ENSIONS OF GIRDERS 3HT OF FOUNDATION THICKNESS OF FOOTING '.F.RIAL OF CHIMNEY X JILDING ON SOLID OR FILLED LAND IIL.DING CONNECTED TO.NATURAL GAS LINE IAORTH Town of tAndover iD = over, Mass., /— SooCOCMICMEWICK I� V ADRA TE D P`P�\ '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.. .....A.R y...�" �40P n � 44.4-Ad.......................................... BUILDING INSPECTORFoundation has permission toweei....F !� �.. ...... b Wings on '� � , Rough �N.�. .. .I........ .......... to be occupied as...B.AAQ.rv%0 kx r R ro o Chimney provided that the person accepting this permd shall in everyrespect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By- ws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 41 / 101 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI N TARTS ELECTRICAL INSPECTOR 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. IFSEE REVERSE SIDE Smoke Det. BOARD OF BUILDING-REGULATI0NS i icense CONSTRUCTION SUPERVISOR Number SCS` 058245 ,'. Birt� a'fe03/24/1943 ES�p::[res z 03�r24�20p6 Tr.no: 21031 1 Res�tnYate2i 0�- ; , KENNETH,,I KEEN, 1 F. 21:HEWITT AVE NANDOVER, MA 01845- Acting C nmis _oner i ✓. -eom�ii'aa uuea� o�✓�aoac�i�caPt( j:a� Board,-64tdldin Oegulati6ns and Standards ; HOME IMP OGEMENT CONTRACT-'R Registratd 108383 ` Ej Tra D 12006 Al KEEN•CONSTI�U rt Kenneth Keen 21 HewittAve C`4 % �. ,� No.Andover INA 01,05 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents , N Officeaf/nnestigations 600 Washington Street Boston Mass. 02111 Workers' Compensation Insurance Affidavit eat. name_ N t" , �EtJ cat'o 7,1 116-LU I 47 6 r"/�S ZOl ❑ I am a homeowner performing all work myself. L�/1 am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. n na e• address: phone# 16-mince c ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices. na a dress. phone#: insurance co: !a:,Y ,m.., address. stay ..: tihone# insurance co cv# �t iSFA Failure to secure coverage as r�yuired under S«tion ZSr1 of l�[GL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years imprisonment as well:is civil pcnalt�cs in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the D[A for coverage verification. I do hereby certify under the its and penalties of perjury that the information provided above is true and correct. Signature Date Print.name rJ N.1—�� . � Phone# official use only do not write in this area to be completed by city or town official,_.;.... ._ . ..- city or town: permitAicense# nBuilding Department O check if immediate response is required OLiccnsingBoard' - pSelectmen's Office 0Health Department contact person: phone#; Other s ixr .. <....wx ti. <_•KSsiUv2 y (revised 3195 PJA) 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 Building 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. The debris will be disposed of in: _'Gzd� A �w SE t1 U ; c t (Location of Facility) OSignature o ermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector KEEN CONSTRUCTION CO. 21. HEWITT AVE. N. ANDOVER, MA 01845 (978)691-5201 Casha, Larry& Mary 67 Settlers Ridge Rd. N. Andover, MA 01845 (978)258-6290 Contract# 1646; Appendix A Date 12/8/04 Basement gym& hall: • Create room in basement for gym and hall from stairs to back door (approx. 525 sq. ft.) • Frame existing rear wall to accept 3'0" x 66" 15-lite door blank • Supply& install R-13 insulation and vapor barrier on all exterior walls • Supply& install blueboard on all finished walls and skimcoat plaster to smooth finish • Skimcoat plaster existing stairway walls to smooth finish • Supply& install oak treads & landing on existing stairs with painted risers & skirts • Supply& install oak handrail& newel post with painted balusters • Supply& install 1-lite door into gym from hall • Supply&install three 6-panel semi-solid smooth doors (1 each for bath, electrical room& boiler room) • Supply& install trim on doors and base to match existing • Paint walls & trim (2 neutral colors, 2 coat finish) • Supply& install 2' x 2' revealed edge suspended ceiling with 9/16" track and Dune series tile Plumbing: • Relocate sprinkler pipe where it comes into house • Relocate clean-outs in soil pipe to be accessible in future Supply& install flush sprinkler heads in ceiling to replace existing • All heat (1 zone in gym, 1 zone in hall with future loop for bath) is included on boiler contract dated 11/30/04) Electrical: • Supply& install outlets & switching to code • Supply& instal 9 recessed lighting fixtures ( 6 in gym, 3 in hall) on dimmers Total Price:$22,200.00(twenty two thousand two hundred dollars) 1 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978)691-5201 All extras to be paid in full upon ordering. Price,does not include cost of permits, flooring, bath in basement, or hardwood flooring medallion on landing. Payment schedule:$2000.00 due upon signing contract -pd. Check# 6153 $5000.00 due I" day of work &t o 5 $3000.00 due when rough framing is complete ' .$3000.00 due when rough electrical is complete✓ $4000.00 due when walls are plastered $3000.00 due when.railings are installed $2200.00 due at completion of contracted work J i Cu tomer kenne B. Keen Date Date 2 1646 KEEN CONSTRUCTION CO. Ef 21 HEWITT AVENUE PROPOSAL NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978)682-3231 specifically exempt from registration by Provisions of Lr Chapter 142A of the general laws,must be registered with Submitted L_C r �/}C l; the Commonwealth of Massachusetts. Inquiries about To: ... �v r `.1� :�. q - - regi,5tration and status should be made to the Director, rw�t� r l .l Home Improvement Contract Registration,One Ashburton ----. -----,. -.-- _._._.__....._ .... .._ .._........ Place, Room 1301, Boston, MA 02108 (617) 727-8598. V � i � , Owners who secure their own construction related I �► permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. � c� " 7 5 S �c �-���' r5 MA. H.I.C. 108383 04-325-8052 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: ......... ......�....... . ._. 0 I . onstruction related permits. .............................................................................................................................................................................................................................................................................................................................................................................................. WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in-writing. Contractor will henin the wnrk ,. �. " Location �z .Sv Ille -S oa"el9e Ir No. 3,9Date r NORTh TOWN OF NORTH ANDOVER � n } Certificate of Occupancy $ �' b'•^°''t�' Building/Frame/Frame Permit Fee $ 10 �ss+cwuse 9 Foundation Permit Fee $ 3 Other Permit Fee $ TOTAL $ 3/D 990 Check # Building Inspector t 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUC REPAI RENOVATE, OR DEMQLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER; DATE ISSUED: rn SIGNATURE: Building Commissioner/I ctor of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Numbel 13 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R aired Provided Q 1.7 Water Supply;;G.L.C.40.5 54) 1.5. Flood Zone lnformatiou: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System. 0 _J SECTION 2-.PROPERTY OWNERSIIIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Print) Address for Service: Iv Signature Telephone I 2.2 Owner of Record: Iva e not Address for Service: Z M Si n'hture Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O ,�i License Number Address Expiration Date to Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ o Company Name 2,323 rn y ,n Registration Number r Address N yt� e,l--Al 6) 2 Expiration Date re Telephone SECTION 4_Wp RKERS COMPENSATION(NLG.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 buildin rmit. t Si ned affidavit Attached Yes....... 1'Jo.,.....0 SECTION 5 Descri tion ofPro osed Work check all a aq ble New Construction 0 Existing Building ❑ Re it Pa (s) ❑ Alteratigns(s) Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: Ppo fr x1c54/h SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cosi(Dollar)to be I. Building Com feted b � '' ennit a licant 1 2 a 0 (a) Building Permit Fee 2 Electrical Multi lier (b) Estimated Total Cost of 3 Plumbin Construction 4 Mechanical HVAC Building Permit fee .X (b) 5 Fire Protection 3/C)6 Total 1+2+3+4.+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize My behalf, in all matters relative to work authorized by this building pennit application, to act on Si nature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date 1,. �� E .property a&-Q4m=#Authorized Agent of subject Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowled e (� and belief g k . Prin e Si ire of er/A entl t2' _07`` Date NO..OF STORIES SIZE BASENIENT OR SLAB SIZE OF FLOOR TIMBERS 1, 2 SPAN 3 DIIvINo ENSIO IS OF SILLS DIMF,NSIONS OF POSTS DiM 'NSIONS OF GIRDERS HEIG ITr 0 FF OUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMgEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ✓lie -�io�nmcoow�eal�/z a�./�aaaa�u?� ,.s Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:- 108383 ` ExWratlon: 8/1812006 lug Type: DBA KEEN CONSTRUCTION CO. Kenneth Keen t. 21 Hewitt Ave ... '✓ No.Andover,MA 01845 Administrator GTS -�� � �✓l��l BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 058245 Birthdate: 03/24/1943 .% Expires: 03/24/2006 Tr.no: 21031 Restricted: 00 i KENNETH B KEEN s 21 HEWITT AVE *,�Ilsoer N ANDOVER, MA 01845 Acting C— The Commonwealth of Massachusetts -- y Department of Industrial Accidents Officeo1/mrestigatiow 600 Washington Street /l Boston Mass. 02111 Workers' Compensation Insurance Affidavit location: situ f7NC� 0 LJ�2 �/f phone# / 7Q"6 r �S Z.O ❑ I am a homeowner performing all work myself 0111 am a sole proprietor and have no one working in any capacity !777777 EMMENEMMMMUMMMMMEMM this job. city _ ;tddress� ' phone# Xb msurlince co policy# 1za vM R ,. ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: ctimotiny name address: insurance co anyPit?, OEM name: address: s�tvi phone# msurnnce co policy# iltcd'dhnal§luEx�;fne�cssar Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 31,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the its and penalties of perjury that the information provided above is true and correct. l' Signature Date Print name ��S ri to-& ..!? ..>I CG�. ..... .. _ , . _._ ._ ._._. . Phone#g_.7"9 .,. �1�i l'' �,. official use only do not write in this area to be completed by city or town official ..., .. city or town: permit/license# -Building Department ❑Licensing Board C]check if immediate response is required pSelectmen's Office QHealth Department contact person: phone#; -Other y* N,�„ (revised 7/95 P1A) 1 �1ze �omvmoouuea o���aaoczc/ucael�a i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR j Number�:CS4 058245 i Birthda ,03/24/1943 Eitpires 03/24/20:06 Tr.no: 21031 i Restricted 00 KENNETH B KEEN a 21 HEWITT AVE N ANDOVER, MA 01845 ActlnS(CdjAmisF#oner �1LC V/Oh1.LIlE�UL 0�✓l�L(W6(�CiLU� } .1N�T, j \ Board of iiuildiug,Regulations and Standards i., HOME IMPR0V,EMENT CONTRACTOR x . Registration., 108383 Ez rt atfii --� t 1.� fl 8/2006 7e -DBA fIw KEEN CONSTRUGTIOONi�CO. f Kenneth Keen 21 Hewitt Ave No.Andover,MA 01845•. f Administrator �` - NORrry Town of 0 .- 'k No. 3 3 9 dover, Mass., // — /2 T O - LAK COCMICMEWICK 7�S RATED 1'4" (5 U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System d N JV � i BUILDING INSPECTOR THIS CERTIFIES THAT..�/.4.'h.. 6"/4 .......................... ................ ............................................................................. Foundation A0 4......... buildin s on .. 4.1 S A'ITrj.0���..... Rough has permission to erect. F?A!!.SV � '� to be occupied as y0� / A t�M�.I�� Chimney provided that the person accepting 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 relatin to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. G 'O PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final IT PERMEXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ...... . #0 ..4�W... BUILDING INSPECTOR Service 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. KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Casha, Larry&Mary 67 Settlers Ridge Rd. N. Andover, RIA.01845 (978)258-6290 Contract # 1631; Appendix A Date:10/14/04 Create basement room: • Frame interior partition walls to create approx. 400 sq. ft. finished space • Supply& install three Andersen TW windows on the back wall (trim ext. to match existing Insulate and install vapor barrier on all exterior walls • Install blueboard and skimcoat plaster to smooth finish • Supply& install 15 lite door from unfinished area • Supply& install trim on windows& door to match existing (paint grade) • Supply& install 5 1/4" speed base(paint grade) • Supply&install standard "704" suspended 2'x 2' ceiling throughout finished area • Supply&.install Kahrs maple Genua 2 strip plank floating hardwood flooring throughout finished area • Paint walls and trim(2 coat finish, 2 neutral colors) • Install customer supplied cabinets&bookcases(as per original drawings) Electrical: • Relocate electrical service panel and all wiring (including phone, cable, and computer wires) • Supply& install outlets to code • Supply& install one phone outlet & one cable outlet • Supply&install eight recessed lighting fixtures (on dimmer switches) PIumbing: • Relocate sprinkler system drain and install new flush sprinkler heads in ceiling Heating: • Create 2 zones off of existing HVAC furnace (1 for first floor, 1 for new room in basement with trunk line for future bathroom • Supply& install one standard thermostat Total price:$30,792.00(thirty thousand seven hundred ninety two dollars) 1 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Price does not include saw cutting floor for wires at table or installing wires at table, leveling of existing floor, exterior painting, cabinets, bookcases, countertops, or any related permits. All extras to be paid in full upon ordering. Payment schedule:$1000.00 deposit (paid check# 6031;; 0/2/04) " $8000.00 due upon signing contact $4000.00 due when windows are installed $4000.00 due when rough framing is complete&electrical panel is moved $3000.00 due when insulation is complete $4000.00 due when plaster is complete $4043.00 due when flooring is delivered $1500.00 due when job is complete except cabinets $1249.00 due at completion of contracted work l j Customer �Fe h Keen Date Date 2 1619 KEEN CONSTRUCTION CO. A 21 HEWITT AVENUE PROPOSAL 144t�o NORTH ANDOVER. MA 01845 Tel: (978)691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978)682-3231 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with Submitted ff (�} the Commonwealth of Massachusetts. Inquiries about To: ................_..-.(,�._(-...1".�1..............__._.-_.__.......__-._.__.._.._.. ......._._�..____�_._ ---- registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton ---..--_-_-- Place, Room 1301, Boston, MA 02108 (617) 727-8598. � � _ Owners who secure their own construction related 0), Owners C#\`� l.. � .... � _ permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. F.I.D.N0. 2 5 -�2 j �)- (�� -�j �, MA. H.I.C. 108383 04-325-8052 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: ------- __ __ - ---- Construction related permits: ......................._....,_...........,.,.,....,,........,,........................,....,........,,.,...,.............,......,...,........,,......,.........,.............................,........................... ,,,,,,,,,,,,,,,,,;,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,, ,,,,,,,,,,,,,,, E................................,.......,..,.......,. WORK SCHEDULE Contractor will not begin'the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing.-Contractor will begin the work on or about ' '- (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by ' (dale). The Owner hereby acknowledges`and'agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 06 C following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contractor,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, _reoaired,or.replaced,.such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. / I / II I ' � I I ` l Z I � qD � q I t l y I I , , I �;ro' I s G 7 I h I� _ � I N I ; 'p., OG O� 7oui.✓d .9so2fdgG6 co,, iwC, I mmtrBr anrJFr m ria rnLa VM AND PLOT PLAN rO Tom' JAXR MAr rat. DVZLUA,ra r8; or rXJ) QW IN THZ Lor AN SHCON AND radr sr Dora WNFGRU r1l71 TJ9�� >�"� 'N F�.Pov�R *ONIIVG;Ra'tiUlLTIONB Na. /9NI�0l/ /Q /Y7r9 I FQRTHRR DRAIJV FOR LaCAIMD JWW LaDD X�IrtRD 4A&A AS SHOW am P"AL S4 g p LS. MALT rlll8 puX ra maRimGR PuRposms - Arar Fait. JI(R)MMACK RNGLVNrJUMC SBRMES DouAvwy DrtouxAriay. aouwwr INromurxam 8e PAM SFRRSr rAJtTX FROM =SrINO ACC S. AIVDOVaR. Y4S84CHU8J rV8 01810 i ��{� office Use Only G, 4t Lfummuniuralltl Df iEnsar4it5Et5 Permit No. Etpurtmurt of Vublic $sfttq Occupancy A Fee Checked�4� r BOARD OF FIRE PREVENTION REGULATIONS 527 C JR 12:00 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Cade, S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 'F5--7-S 7 Q)G or Town of NORTH ANDOVYR To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street 3 Number) Owner or Tenant Owner's Address FL « y� / Is this permit in conjunction with a building permit: Yes ✓ No r (Check Appropriate Box) Purccse of Suildina 1 -�5 Utility Autnorization No. --�nk:,iD 2_--- Existing Service Amos _J Vcits Overhead _ Unagrnd No. of Meters New Service -�,QQ Amps /Zy/ Volts Cverheac _ UncS,no No. of Meters Numoer of Feecers anc Ampac:ty Lccaacn ane Nature of arccosea Elec:ncal :`/crx Totat Na. at ::gnung Outlets Z� I No. c: Hct ',;cs i No. ct 'ranstormem KVA No. at L;gnting Fixtures Swimming Pcot Aoave.— :n• — z S grna. _ grnc. _ I Generators KVA I I No. of Emergency Lighting No. it Recectac:e Outlets No. of Cil turners Bacery Units / No. of Swttcn Outlets No. cr Gas Eurners I FIRE ALARMS No. of zones Tota: No. at Cetection ano No. of flanges Na. c! air C.rc. tons initiating avtces No. of Oisaosats ( I Na.ar Heat Total Total ?u-=s Tons Kw No. at Sounaing Oevtces Na. of Satf Cantatnea No. at Dtsnwasners - 1 I ScacerArea Heactrg Kw Oe;ec::anrSounatng Oevtces No. at Oryers Hea::ng Cevices KW Lccai - Muntcioai --Other Connec::on No. ct Na. Jt Law Voltage No. of Water Heaters KIN I Signs Badas:s Wiring .. . � No. Hvcro Massage Tubs '4�, No. of Motcrs Tocai HP I - OTHER: INSURANCE CCVERAGE. Pursuant .a the recutrements at %tassac-,.:sons ;enerai Laws I have a current Liacnity Insurance Poncy tnc:uctng Cam^:ete cerat:cns Coverage or as suos:antral ecutvaient. YES e----N0 = I nave suamtctea vatic ;.root at same to the Office. YES = If you nave cnecxea YES. -tease tnatcate :ne type of coverage cy cnecxtng ;tie appraort to oox. INSURANCE BOND = OTHER = (Pease :cec:'y) �0 �`w (Exotratton Oatei Esttmacea Value at E!ec:ncat 'Nora S ��O• 4 Warx :o Start Inscec:ton Data Aacues:ac: Rougn Fnai Signea unser :he Penaittes at perjury! FiAM NAME ✓` � ��^ ` — S �'`�`L UC. NO. �Z�P Licensee/n � �� MG, SIS attire LIC. NO. � �d �� Bus. Tel. No. I^ 1 uwo� S i tP1 r S1sv �, ✓t-� 3�65 ,act. Tet. No. Acoreas � OWNER'S INSURANCF-WAIVER: I am aware mat the t:censee aoes not nave the insurance coverage or its suostanttal eautvacent as re• autrea oy Massacnusetts General Laws. ana that my signature on :n:s cermtr acpttcacton waives this reautrement. Owner Agent v (P!ease cnecx ones 'eteonone No. nAMIT FEE i iSignature of owner or.tgenn +t-45n5 Date:?— ..... .../. ...... 10 HOR71� TOWN OF NORTH AIvdOVER PERMIT FOR WIRING SACNUS� e This certifies that ...... .......... ....,............. has permission to perform Le.� ' ....................................................... ........ wiring in the building of — 'r -...0 .. .. ................ �Y�.G .....................North Andover,Mass. Fee ..... Lic.No:'�?RXZ4 ............................................................... ELECTRICAL INSPECTOR All 1/3 ;1/9 G6�Il�A Iii� 186.60 PRID WHITE:Applicant Bui Gin16g Dept. PINK:Treasurer t C.BTII Office Use Only C7 3 it I >;IIIIuwra�I � MFI sar4usitt5 Permit No. 1' r!� . Etparttntnt a f puhlit ilfttq Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CS1R 12:00 3/90 peeve blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Qx or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. L Location (Street & Number) C-O( `� �c��.� S ,,� ,��,C �� I 67 Owner or Tenant I '^-� C-- _ t C�•-1 > '"� —t— Owner's Address c.CC&O• Is thus permit in conjunction with a building-permit: Yes _ No r_- (Check Appropriate Boxy Purccse of Buildina V2-4:75 n--Ll Utility Authorization No. 71 j/Q Existing Service Amos _J Vcits Overread _ Unagrno r No. of Meters New Service Amps _J Volts Overheac _ Uncgrno I_ No. of Meters Numoer of Feecers anc Amcactty Lccaucn aria Nature of Prccosec Elect.:cal .1/crx Talar NO. of L:gR;tng t7Utlets j NO. z' '.Hct '%-cs No. cf :ranstormerti KVA No. of L.gnttng Fixtures Swimming ?cat Aoaver— :n- No. _ grnc. _ I Ganerators KVA I I No. of Emergency Lighting No. at Recectac:e Outlets No. cf Cil Eurners j sarery units No. of Swttcn Outlets No. cr Gas Eurners I FIRE ALARMS No. of Zones Totat No. at Cetection ane No. at Ranges No. VAtr Carc. tons Initialing Oavtces No. at cisoosais I Noor Heat Tatar To tat Pu-=s Tons KW No. of Souncing Oevtces i No. of Sed Containea No. of ctsnwasners - ScacetArea HeatingKw Oetec;onrsounocng Oevtces No. of Oryers Hea.;ng Cev:ces KW Lccat - Muntc cat --Other Connec::an _ No. ct No. of Low Voltage No. of Water Heaters KIN I Signs Sachs;s Winng . No. Fivcro Massage Tubs I No. of Motcrs —alai HP OTHER: INSURANCE CCVEAAGE: ?-.;rsuant :o the recutrements of massac-:;secs ;enerac _aws I have a current Liaouity Insurance Poltcy Incluctng C„nc:ete ceraticns :.;,verage or as suostannal ecutvacent. YES ?/NO = I nave suomtttea vatic proof at same to tris Office. YES — NO = If ycu nave cnecxec YES. please tnoccale me typo of coverage Cy cnecxrng :me aopproa_rrace Cox. INSURANCE Y/3CNO = OTHER _ (Pease Scec:.ya J (Excitation Oatet Esumatea Value at E!ectncal Work 5 tuD. WorK :o Start Inscecaon cats Facues:ac: Rough 'a1 _ Final Signeo unser no Penances of pertury: FIRM NAME c— L �Lt� t—</ccC UC. NO Al)✓L-�C Licensee Ml Gvt�L—� l Nt ��N'`�t 'gnat re UC. NO. 1.Z ^'� `4Aoaress �wl�t� > &7 / �'�� 5 t c�.� 2�r Alt. :al. No. OWNER'S INSUR NCc WAIVER: I am aware trial the L:cens6e aoes not nave the insurance coverage or its sugstantial equivalent as re- outrea Cy Mas3acnU36tt3 Ganerat Laws. ana :hat my signature an :nus .^.ermtl aapttcatton waives this regwrement. Owner Agent (P!eass cnecK ones 'eteonone No. PlEAMIT FEE S.SL� iSignaiure at owner or.tgentt ■%roo� r PEI MIT NO. 7 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. _oe PAGE 1 4 J, MAP K40. ' LOT NO. �(' 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. rz2 ;e ��, �-Z _ � f , 32.1 ki 7_ LOCATION C� - PURPOSE OF BUILDING �� R OWNER'S NAME 14 �A ( �`� v ���lll/// NO. OF STORIES t SIZE OWNER'S ADDRESS I�' BASEMENT OR SLAB b.AfL�R� ARCHITECT'S NAME ,!' - SIZE OF FLOOR TIMBERS IST � �� 2ND �yr3RD . .....__. 1 B'UILDER'S 'NAME . . .._ .SPAN. . DISTANCE TO NEAREST 13 ILDIN f ,, DIMENSIONS OF SILLS .• YAC? - DISTANCE FROM STREET �1► POSTS 3 I/__ r /e L& C� DISTANCE FROM LOT LINES — SIDES •��l REAR /I���L GIRDERS / ko, ,. m AREA OF LOTq 31 3C W FRONTAGE Gdf Y�� HEIGHT OF FOUNDATION C T/J THICKNESS/d IS BUILDING NEW C� ,!)/)/&_:s ( SIZE OF FOOTING O -/ 1, X z6 1, ti IS BUILDING ADDITION N d> MATERIAL OF CHIMNEY /<, IS BUILDING ALTERATION . A IS BUILDING ON SOLID OR FILLED LAND( rN i WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER I}� BOARD OF APPEALS ACTION. IF ANY A IS BUILDING CONNECTED TO TOWN SEWER /t l� - J�J c,i� IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 13 PROPERTY INFORMATION SEE BOTH SIDES LAND COST )2,01 {01 060 6/o EST. BLDG. COST IL--f 3 ('3�\ PAGE I FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ.FT. • _... ETT. BLDG. COST PER-ROOM �`•a `� y � -_. PAGE 2 FILL OUT SECTIONS 1 - 12 - SEPTIC PERMIT NO. &). JI • ELECTRIC METEPS MUST BE ON OUTSIDE OF 6,UILDINd-_ 4 APPROVED BY '•"' ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS - J PLANS MUST BE FILED AND APPROVED BY.BUILDING.INSPECTOR - DATE FILED �! " //� _ .. .... . . .... WILDING IN<P[CTOR " IGNATU E OF OWNER AUTHORIZED AGENlf �. F E E 0 yj&2 OWNERTEL#..._ PERMIT GRANTED � s �V �` �[ t� t jaiy CONTR.TEL.# `�^� 3'3 v i>i 7i'i3NA .r.�. CONTR.LIC.A DIM FNIK PERMIT H.I.C.ry �� �� a �� 1 1 5 . II BUIL.DING,;.RE.CORD 1 OCCUPANCY 12" MINGLE FAMILY STORIES �- TFIIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT A.ND DISTANCE FROM $ 4 MULTI. FAMILY OFFICES 'LOT LINES AND EXACT 'DIMENSIONS OF :BUILDINGS. WITH PORCHES t GA- APARTMENTS RAGES.-El`C. SUPERIM"l:lOSED.'*HIS REPLACES PLOT PLAN. CONSTRUCTION s. -2 FOUNDATION 8 INTERIOR FINISH CONCRETE^... Bt_ 23. . € CONCRETE B PINE !— -0" BRICK OR.S7pNEHARDW'D Pi FRS PLASTER _ DRY WALL .. ._. _....__. UNFIN. . 4 3 BASEMENT -• - .. - { ,•.• AREA FULL FIN. B'M'T' AREA I 'h 1/E °/. FIN. ATTIC AREA NQ B M'T FIRE PLACES 7 HEAD ROOM _ 'MODERN KITCHEN 1. 1 '4 WALLS 9 FLOORS ?7.4 CLAPBOARDS B 1 2 3 ; DROP SIDING CONCRETE ——�_ WOOD SHINGLES EARTH ASPHALT SIDING HARMU D _ ASBESTOS'SIDING COMMGN _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ "Y BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING :c STONE-ON FRAME__... "f , SUPERIORPOOR _ - ADEQUATE I NONE - •" •5 OF: 10 PWMBIN'C.. GABLE HIP BATH Q FIX.) Z GAMBRELl. MANSARD TOILET RM. (2 FIX.) - •-, — _ FLAT I SHED WATER CLOSET ASPHALT SHINGLES ' LAVATORY WOOD SHINGES KITCHEN SINK '? SLATE NO PLUMBING _ I 'TAR 6 GRAVEL STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES } _ _...__. TILE FLOOR TILE DADO FRAMING Al HEATING.. WOOD JOIST PIPELESS FURNACE FORCED HOT AIR•FURN. TIMBER"9Mf,COLS. V, STEAM " STEEL BMS. 6 OLS HOT W-T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING 5 RADIANT H'T'G UNIT HEATERS GAS y NO. OF ROOMS OIL B'M'T 2nd— ELECTRIC o pii 1st 1-3rd I NO HEATING t MoAb L, 1T PR �Pd�i l'> `IrE PLAN DATE l ' 00 — __ -- _- S. H. . '9+00 _ Tara Leigh Development Corp. 185 Hickory Hill Rd. N. Andover,+ MA 01845. ) _ I -w Z Q p pos 5Dd 1 W Fk s�E-T t ` 06 NQS\ • ,ice � 8 c►OR4. T own of- _ 4 over No. yo 7 M 199' z dover, Mass., / -COCN10- ICNE •�S OAA T E D�pP`y BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.................... t�R.. ...............Fe-6,q.......... ..Pir J. .......... .tQ.. ................... Foundation has permission to erect...................../................ buildings on .....Co..7........� . ,L. .5........ Rough tobe occupied as....................................., /../k�..6' ;!=401............ Y....... ......................................................... chimney provided that the person accepting this permit shall in every respect conform to a 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 EMPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ,*T TS ELECTRICAL INSPECTOR 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. - • FORM U - LOT RELEASE. FORH INSTRUCTIONS: This form is used to verify that all necessary appkovals/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:- e Phone _46e?-&3 LOCATION: Assessor' s Map Number (0/ Parcel Subdivision Lot(s) / Street �J R� St. Number 4 -7 Use Only************************ RECOMNE1' TIO OF TOWN AGENTS: bate- Approved 1 �� Conservation Administrator Date Rejected Comments ; Date Approved 4 i'ow Planner Date Rejected ' Comments Date Approved �iealth Agent Date Rejected Comments Public Works - sewer/water connect-ions ll 7_ driveway permit Fire Department r Received' by Building Inspector Date CERTIFICATE OF USE & OCCUPANCY Town of North Andover Tl- Building Permit Number 407 Date April 7, 1998 IS CERTIFIES THAT � THE BUILDING LOCATED ON 67 Settler Ridge MAY BE OCCUPIED AS Sitgleelling IN ACCORDANCE : WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND r: SUCH OTHER REGULATIONS AS MAY APPLY. T A., "°o'; CERTIFICATE ISSUED TO Tara Leight Dev ° 185 Hickory Hill p ADDRESS ,ss4cmus�� 41 j uildin nspector a 1 � NORT 0 0 _ ndover No. � s dower, Mass. - •1 19 , - LAKE •' � � r A 9 COCNICNE WICK y7�• A0,t4 ED►PP`y '�� S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT..................................I..........................,....!....:................................:'... ....................................D.............. Foundation has permission to erect........................................ buildings on ..... .rf.......1:; ..OIL. ............ �' Rough tobe occupied as............................:..........:...........................,:....................It Chimne.............................................................................. y provided that the person accepting 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. PLUMB GINS, 1 , VIOLATION of the Zoning or Building Regulations Voids this Permit. I�ou Iti'Q� 1 1 F' a IV- PERMIT EXPIRES IN 6 MONTHS -� UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ............................:...................!......................If.......................................: Service i BUILDING INSPECTOR Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough �0 s� p Y P ' a� No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FII& DEPARTMENT Burner Street NO. Smoke Det. ti •••r�.�anvalV.�c■ •v �•��� v�»•� �.-�-"e:l�:t�►���7i l�t'Z77�—t''� mgr�I :��t7�•:�+�:p'�(�N,B� � •�r. (Type or Print) NORTH ANDOVER* ,Mass. ,.�:4: `::,Date ' .Oats:''•/ "' - t� Building Location �'iT� �S c�:© ��� Permit •T Owners Nam ! v New Renovation Replacement Plans Sybmitted II FIXTU F N z Y < F h O q O O Z h a J W Q Za . N < {c oC = 2 O ?. q 66 J ltl W fp q X h U W 0 Y < in k _ 2 1. O a OC < aC Q W Q 4 O Z i s 0. !t. O. f V < Y X X CL X x. Y d O !• • ..;; < ►� < < i H 4 Q 0 OJ O 4 O a tti oWG < V O .c h SU8•-1B S MT. BASEMENT IST FLOOR 2ND FLOOR o� 3RD FLOOR 4TH FLOOR STH FLOOR , Now 6TH FLOOR 7TH FLOOR BTH FLOOR (Print or Type) Check one: Certifica1 Installing Company Name T@w-,c,l>e- Corp. Address /,Z Partner. �`c.�J �'O 1•v /r•1-�•� �� d'S'�' - Firm/Co. Business Telephone /-(,> b3 3PZ 7A.t f Name of Licensed Plumber: � �+ ►Q.c��.�-� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: 1 Liability insurance policy arother type ,of indemnity 0 Bond Insurance Waiver: 1, the undersigned, have been made aware- that the licensee of I this application does not have any one of the above three insurance coverages. . . Signature of ownerlagent of property Owner Agene,. •, i Il bmbr ceslifr Wal all of dic dclails and ia(080131ion 1 havc suLmil lcd(os cnincd)in ah••.e aM•liotioo Ne IsYe and tyals to IM mal M w • k"wkd&a and that all plumbing work snd inslallaGnns lip(nimcd undcs Pcintil issucd fos this applicuiat wiA be in si.h —I I �jiinsla Y(dw Maasubwells Slate numbiar Code and Qsapics 141 a(llac(:coccal Laws. /�(J . j Title • Si nature of"Licensed Plumber � City/Town: Type of Plumbing License i .. l%S$ t. Dope)vr:n 70FF1CF USE Ortl_Y1 License Number tJ MdSttt [] Journeym4 .9"• Date!.1. . t35?6 A i pORfry � r �'. •° •1�o TOWN OF'NORTH ANDOVER 0 . PERMIT FOR PLUMBING k �SScHusco f� r r� This certifies than. . . . M has permission to perform . . . . . .rr 7 . .I��C�tt%f .•e�r� plumbing in the buildings off.,. . . . . . . at le. .. -. . . . . . ., North Andover, Mass. Fee,/e�r,. . . .Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR t y l� . WHITE:Applicant CANARY:Building Dept. PINK:Treasurer _Wjlfw,4�ro Building • Locatlon� —� � Permit #r , Owner's Name i �e ✓ :. New Renovation O Replacement p Plan' Submitted; Yet Q No p ., W ~ c O N lo. e: 0 j � scu '°. o � � y i n x 0 ►. A f. z c o h c M c o O : w IM c » r= v s « M H i► 0 cJ* i I�ir J F H Fr-0 0 M. oc > a o IUA—IItaMT. •Ati[MENT � , IIT FLOOR / !MO FLOOR SRO FLOOR 4TH FLOOR ITH FLOOR i ®TM FLOOR TTN FLOOR !TK FLOOR Installing Company �'C Check one: Cerlgiute Pa Y dameP l2r,�_ '� L�9T.1�J�,. � Corp. Address /ot Li1,-,l {&e.,( � d d - /ve Lu-7Z�c1 o u y J, Partnership _ 11 Firm/Co, ----_ Business Telephone 6 b3 9 Nttmo IN Ucensed Plumber or Des Fitter -C/enk; INSURANCE COVERAGE: n 7. 7 1 have R curtent liability Insurance policy or Ile substantial equivalent. YescYp IE you have checked ►ea, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy t�' Other type of Indemnity O Bond O OWNER'S INSURANCE WAIVER: ( am aware that the licensee does not have the Insurance coverage requbed by Chapter 142 of the Mass. General taws, and that my algnalure on this permit application wakes this requirement. Check one: ►a of Owner or owner's evin, owner 0 Agent © , I hraby certify that aq of the details and Iniormallon i have submitted (or aniered)In above application are true and accurate knowiedge and that all plumbing work and Instalialions rformed under the permh Issued lot this application wig be to Itu beet of fny WAMent plovislons of the Massachusetts State Uas t�da and Cfiapler 112 of tM r t s,We compliance with all Type of nae: umber �L Iter na urs o nae um of or as er C"yR D•loumeyman License IJumbet �/S- � Irl'MD(orFICE USE oNLy) r 5 .Date _... .. 0........ „prrTH TOWN OF NORTH ANDOVER pf ��a° ,^1�0 �? '� + PERMIT FOR GAS INSTALLATION 1SSACHU5Et A This certifies that` .. . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . co has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . .I . . . . . . . . . . . . . . . . . . .. . . . . � at .'. .% . . . . . . . . . ..... . . . . . . .... , North Andover, Mas Fee X'-. . . . . . Lic. Noz/v . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR J�J WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Location - o No. Date 12-1--2 QS� ^TM TOWN OF NORTH ANDOVER f R 9 :'a Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ sAcwusE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �a Check # -31 �© rj 3 Building Inspector ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIJ RENOVATE, OR DEMQLISII A ONE OR TWO FAMILY DWELLING tN11RU 01 .< BUILDING PERMIT NUMBER: I DATE ISSUED: _ 00 _ 3 _o rn SIGNATURE: Building Commissioner/l ctor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 :Assessors Map and Parcel Number: yew 7 Map Number Parcel Num er 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 Required Provided Required Provided Q 1.7 Water Supply.KGL.CAO. 54) I.S. Flood Zone Information: 1.8 Sewerage Disposal System: PuMic 0 Private 0 Zona Outside Flood Zooe 0 Municipal ❑ On Site Disposal System. 0 J SECTION 2-.PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record LAlLa c. Name(Print) Address for Service: � � z • Gz � Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Si nIture Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 0 K Licensed Construction Supervisor. O E License Number Z l w1.; 7Z -t1 Address 1 't7 Expiration Date re Telephone 3.2 Registered Nome Improvement Contractor Not Applicable 0 Q Company Name �� ,� ✓C ,/1 Registration Number r Add,Ass � r"A 6 ZO Expiration at re telephone SECTION 4-Wp {ERS COMPENSATION Workers Compensation Insurance affidavit must be comp eGd and.swfsrruttedsty th).fhis:application. Fa'lu in the denial of the issuance of the buildin rmit. Failure to provide this affidavit will result Si ned affidavit Attached Yes SECTION 5 Descri tion of Pro used Work check all a (icable New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg, 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: v SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ed b errrut a licant ' 1. Building Com let t 60 (a) Building Permit Fee 4 2 Electrical Multi lier (b) Estimated Total Cost of 3 Pluinbin Construction 4 Mechanical HVAC Building Permit fee(,).X M 5 Fire Protection > 3p 6 Total 1+2+3+4.+5 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHENber OWNERS AGENT UR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Hereby authorize as Owner/Authorized Agent of subject property My behalf, ill all matters relative to work authorized by this building permit application, to act on Si nature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date I /J P E property ,a&- Authorized Agent of subject Hereby declare that the e, to the best of my knowledstatements and information on the foregoing application are true and accurate, i l and belief. ge � Prin e 3i ire of er/A ent. Date TO,OF STORIES ;ASENIENT OR SLAB SIZE IZE OF FLOOR TIMBERS 1.. NO PAN 2 3' IMENSIONS OF SILLS IMF,NSIONS OF POSTS IMENSIONS OF UIRDERS :1UNI 0 FF OUNDATION THICKNESS 7—E OF FOOTING X 4T.ERLAL OF CH9VMY BUILDING ON SOLID OR FILLED LAND 1 BUQ,.DING CONNECTED TO NATURAL GAS LINE � 3 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS' 058245 Birthdate 303124/1943_ Expires .Q312412Q06 Tr.no: 21031 t tRes �0 YKEEN, KENNETH B KEEN s 21 HEWITT AVE N ANDOVER, MA 01845 Wc—tinj CcVnmisf#oner ,p� r'l� -�� � o�✓�aQaaclucGeaa � 3 '\ Board of ilitdirig,Regulations and Standards { HOME IMP,ROV,EMENT CONTRACTOR t Registration t 108383 Ezpirat an=8 1812006 F t p D8-k KEEN CONSTRl1 ICQ t Kenneth Keen ��� ? . 21 Hewitt Ave No.Andover,MA 01845 Administrator ........__ The Commonwealth of Massachusetts Department of Industrial Accidents 1� � - �^=�,, �� Olficeol/nnestigatiaas r 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit " l an�'�in� rm�afi'on`"x.,�" ,��,; �,- • - . .. _...._.. _ ..."._�,...� ease al!�•.. eai came: J� £ dN E t-/ .. ..�__KJ. �E�.....�....,_. ,...�..._.,.. • location: 2l ;Yeaj r* 17 h'o C city Ay O L)£"2 �Vt hon # / 7�- 6 ❑ I am a homeowner performing all work myself. Lyl am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. t:ompal3y name. . . . _.: address: -i,, — '-- -hone# insurince co. III all= ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: com�.y:name, _ K. a dress, city; ... .. f}hdntr# insurance co. obey#' company name: add re phone# insurance co oofley' i2a # At�c'�tddttlnaI.-.ee tfjnecessa�r:. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the ns and penalties of perjury that the information provided above is true and correct. Signature Date '►.'Z ell- Print name .*4 (? �.-e� Phone . ..... . ... . .. . ._._ ._. ._._. (� official use only do not write in this area to be completed by city or town official,_._.... . city or town: permit/license# -Building Department " pLicensingBoard' _" " p check if immediate response is required pSelectmen's Office 01iealth Department contact person: phone#; -Other (rovi:ca 3/95 rlA) .r . 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 Building 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. The debris will be disposed of in: (Location of Facility) Ao�ilSignature of Plermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Casha, Mary& Larry 67 Settlers Ridge Rd. N. Andover, MA 01.845 Contract # 1537; Appendix A Date.-2/23/05 Farmers porch conversion: • Remodel front farmers porch as per Damarc Designs dated 2/14/05 except where customer has changed • Remove deck boards and existing posts • Jack deck frame to level. • Remove siding windows and sheathing Frame walls with 2" x 6" on exterior, 2" x 4" on interior • Supply& install Advantech sub-floor on deck • Frame floor of dining room portion to match floor level in dining room • Supply& install insulation of walls, floor& ceiling as per prints • Reuse two dining room windows if possible • Supply&install new Andersen TW windows as needed on front facade (at $500.00 per window, 6 new windows included) • Supply& install Thermatru Smooth Star 5139-1D (3'0" x 6'8"} on front of mudroom • Supply& install Benchmark 15-lite steel entry door blank in existing frame replacing 6- panel steel door • Supply& install wallboard and skim coat plaster to smooth finish on walls, ceiling to match existing • Extend existing HVAC floor register in dining room into new area • Supply& install trim on doors, windows &baseboard to match existing • Blend hardwood floor from dining room to new area at same height • Supply& install ceramic tile in mudroom ($3.50 sq. ft. material allowance) • Supply&instal ridge vent on new gabled overhang over front door • Supply& install square fiberglass paneled columns to support gabled overhang as selected by customer • Paint to include walls & trim of two new rooms and repaired walls of existing home (2 neutral colors, 2 coat finish). Paint to be supplied by customer Electrical: • Supply& install three recessed light fixtures in mud room& one in gabled overhang • Supply &install switching and outlets to code 1 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N..ANDOVER,MA 01845 (978),6191-5201 Plumbing: • Supply& install two zones of FHW baseboard heat as required in each new room off of existing boiler(both zones to be filled with antifreeze mix as needed) Price does not include cost of permits,exterior granite stoop, sanding or refinishing existing dining room floor, dining room chandelier or wiring. 6Yt(zi0/ ?A N f%'�✓ Contracted work to be completed in spring or"'hen Bather permits for installation of exterior support.columns(when granite stoop is installed) and Durarock skirt around bottom of deck. Total Price:$43,160.00(forty three thousand one hundred sixty dollars) Payment schedule:$5000.00 due upon signing contract f 4 1 $10,000.00 due the.first day of work,. $15,000:00 due when framed & weather tight excluding entry door $5000.00 due when plastered $7000.00 due when finish trim is installed $1160.00 due at completion of contracted work Clam , . Customer K e & K en Date Date 1537 KEEN CONSTRUCTION CO. Am 21 HEWITT AVENUE PROPOSAL 1%�o NORTH ANDOVER. MA 01845 Tel: (978)691-5201 All home improvement contractors and subcontractors Fax: (978) 682-3231 engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with Submitted y,�_. ,f, j ' t, ( the Commonwealth.of Massachusetts: Inquiries about To: _ �..._.._ ... f c 1 .Zf��Gi. ._.._.__-- -- registration and status should be made to the Director, Home Improvement Contract Registration;One Ashburton ---_._..___..,._.._.._..___ _. _�.....__._...._..__... _ , .__.._. _.__._._...._...._...... Place, Room 1301, Boston, MA 02108 617 727-8598. yy� Owners who secure their own construction related Y76/ �� � j 1 �y permits or deal with unregistered contractors will _. be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. F.I.D.NO. 9_7 0 " 2- -2-7)-c 5 MA. H.I.C. 108383 04-325-8052 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: _ _. ti _... ...._. ............................... r _... _._------.___ onstruction related permits: --- - --•------ ------ __.____ Wt 1 1.................. .....t,f ...... �g.. ..,..� ...1.. ,..p .. ..... ."a_ it ....................... .........�� ... � R�.....L ._�..........,....14..U..'.�..:......... WORK S� HEDULE Contrac r will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here riti yg t otor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by '! l' Ci J (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY EFFORTS OF QAULIFIED CONTRACTORS t Q AND ENGINEERS TO PROVIDE DESIGN/BUILD SERVICES FOR THE ABOVE NOTED SERVICES. N) NOTE J I t 1. A W I r KITCHEN t BE � DW I =I Y GAS STOVE t 2. NEW DRYER VENT CHASE WITH BOOSTER �I N DIRECT VENT OF i FAN TO EXTERIOR WALL. PROVIDE NEW � / HOM FRAMING AND PLASTER FINISH TO MATCH i Foo�O R F GARAGE i I I I ------- - -------- T - - ------ --------- - I t GARAGE TO BE COORDINATED WITH SITE PLAN. ( ��• OS I FAMILY RM. NEW COLUMN TO DINING RM. BE ADDED STYLE ell - 0-TO BE REVIEWED o 6'-10"WITH %H*OMEI 5,-6NOWNEL CIRYER VENT - __ DESK I6 -0 I � CL. ----- 1 FOLD OUT IR ING BOARD - LDY. RM. 3 0' CL. o LIVING RM. ALIGN FLO W I oz I 3'-0" CK DOOR 1 ICAR - - -- a FOYER , I Q } 2 CAR GARAGE o _ ___ DR. R o 11 -3 EX Q I I - CL. � TO (Z2 U- _--_= EX CI I SAW CUT EXISTING 3 ==J I o } FOUNDATION WALL 4" XIST'G. DN 20 zIN DR. ; MUD RM. J 3-1„ 3/4'X11 4X TO N I BIGGER THAN OPNG.� ARAGE a t3'- Q 1/2,r OYL S' NE a I NEW } RELOCATE EXIST'G. 3-DH2456 z 3-DH2456 TC ECT. ELECT. METER�� I ECESSED ENTRY 2•-7" 7'-8• -3• S-0 2'- 7'-s- 2'-r 2� 4ETER 16'-0" X8'-0" GAR DR. DCATION I REUSE EXISTINGPT DECK S 20 -0' ADDITION L- - - - - - - G.C. TO VERIFY PITCH AT PLYWOOD AND JOIST ASSEM EXIST'G. ENTRY TO EDGE FINISH FLOOR TO BE CT IN LOCATE NEW WALL IN---JOF GARAGE. GRANITE STOOP TO BE VERI CENTER OF GARAGE WITH HOME OWNER -•• /1 OVA NO Hul LN o —a= -- - l 11 in =_ ___ a �■ ■, _=, � ,=- ■ ■ PROPOSED ' `SITE E • _NG14EER TO VERIFY - - : • • • ••.- • • • �••- :• • .� • . 1101 TkORTH Town of _ 4Andover _ - iLAo '� dover, Mass. Jw Al a-& DO �A COCMICMEWICK ' '`y . RATE S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System A BUILDING INSPECTOR THIS CERTIFIES THAT......I�,A.�,.�.�"....��.R ��sk ..... ....................................... . ..... . . ... . .. ......... ". Foundation has permission to eretit.. N�I�'� ti p buildings n ........5 �;o' h ................. .........................4a 17 ...to be occupied as..Ir r V dD Iv�� �� mney ....................................... ........................................................................................................ provided that the person accepting 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. G 'f/'Q 7 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCSTS ELE CRICAL INSPECTOR Rough ...... ... ........................ ..... .................... Service BUI ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F nugh al No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE S 1 D E Smoke Det. Date...... � ��s I.. ....... NORTFr °:<«`°.;•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING AcmUS This certifies that ...... ............................. has permission to perform .. '�l..c: .......... J � f 1� ....��••' ��L wiring in the building of. �.......... �,,...4.. ../[. ..:.:.................. ... .. r 1 -Jd �1 J 1�r Jnr �� at....... ...................................... ...... ,North Andover,Mass. Fee. 5Ln... Lic.No.............. ...... ....:r..t ...}�......'. ... i,/ � ELECTRICAL INSPECTOR Check # �I , � S � J Commonwealth of Mass chusetts Official Use Only Department of Fire S rvices Permit No. a a BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _261T UU•� ` [Rev. 11/991 leave blank APPLICATION FOR PER I TO PERFORM ELECTRICAL WORK All work to be performed in accordann& ith the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL TION)TION) Date: /—/G —d5" City or Town of: Mo. /Tw&/M-, To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant /yjt / 4- Telephone No. v%iY Owner's Address 94-fi,4- Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Bog) Purpose of Building_ Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �,K6j �U'vr ol-YGH 4Lt,_, Completion o the ollowin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming kol Above ❑ In- El 0.o Emergency Lighting rnd. rnd. Batte' Units No.of Receptacle Outlets /p No.of Oil urners FIRE ALARMSNo.of Zones + of Detection and ' No. No.of Switches No.of Gas,Burners Initiatin Devices No.of Ranges No.of Air Cond. Tons Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters signs Ballasts blueof Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:, No.of Devices or E quivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) On File Feb/2t;,o S (Expiration Date) Estimated Value of Electrical Work: __r6,0 (When required by municipal policy.) Work to Start: /—/ ,Ds- Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey Signature LIC.NO.:37200 (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.,• 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Alt.Tel.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: $ j-7 00 Date..�.Y.°? � dB� f NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUS�� 4 This certifies that ........ . ... �.... .. ........................................................ t has permission to perform . ' ................................................................... wiring in the building of.. k .. '..�..r`'Gyl''.. >.................... D at... . .......�` :. .. !,North Andover,Mass. Fee...G�?. '.r Lic.No...�� Q�........1 1t �* ELEemcAL INspwmR. Check # L '-- 5 I;. 2 4 NOV-14-2004 10:00 AM KELLYCASEY 978 937 1816 P. 02 � ea/th of Msll llch"Otta NEW)Use Only, Commonw ,tel $I/ Ice Deportment of Firetens m hermit No. r Occupancy and Fee Check �5 BOARD OF FIRE PREVENTION REGULATIONS Rev 11M) leaveblank APPLICATION FOR PER IT TO PERFORM ELECTRICAL WORK All work to be performed le+aceo with the Massachusotts Electrical Codc(MEC),527 CMR 12.00 (PLEASE PRINT DV LVK OR TYPE ALL IN ORM.l770M Date: - City or Town of: u r To the Inspector of wires: By this appli.eation the undersigned gives n0VcJ of his or her intention to perform the electrical work described below. Location(Street&Number) il Owner or Tenant L Ate Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Bol) Purpose of Building Utility Authorization No. Existing Service Amps / Vohs Overhead❑ Undgrd[l No.of Meters New Service Amps / Volta Overhead❑ Uodgrd❑ No.of Meters Number of Feeders and Atnpacity Location and Nature of Proposed Electrical Work: �-amu r?,: 5� , ,i%L-A- C. lotion of thefollow table ma be waived by the Inspector of Wires. No.of 21 No.of Recessed Fizturea No.of Coil.-Su*(Paddle)ftas Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures i Swimming Peoi red. ❑Above ❑ o.o mns is y g ng B tte Unit, No,of Receptacle Outlets No.of Oil Bui;iters FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners NO.o e n a Ttal Initiatiea u Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heallo.of Waste Disposers t Pump Number........_. ...ona _. o.o - ontam ed p Totals:I Detection/Ale Devices No.of Dishwashers SpoWAres HeatingKW Local ❑ un cepa [I Other Connection Secity �\ No.of Dryers Heating Appliances KW No.o systems: ices or E uivalent No.o atero.o o.o Data Whingg: Heaters KW sips Ballast SwofDevien or uivalent No.Hydromassage Bathtubs No.of.Motors Total HPa eNa nl>k'Vicea or rile t. .. OTHER: .4ttach addlitanal detail tf desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical,*ark 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 some to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER (] (Specify:) On File .,.Few --4f-,C,4 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I eeift ander fhepohn and ebl a:ofPerjWry,lka,t t ke btfertt okaa on lett applkaden h tae and catapkft FIRM NAME: LIC.NO,: - Licensee: Kelly M.Casey Signature . LIC.NO.i 37200 (If applicable,enter"mmpt"in the license number line.) ' B+L Tel.No::97&697-4452 Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 -Alt.Tel:No.---- I . OWNER'S)INSURANCE WAIVER: I am aware that the Licensee does not have the liability i uiancie coverage normally required by law. By my signature below,i hereby waive this requirement. I em the{check one)[3 owner owner's Ment, Owner/Agent PEMIT FEE.$ (Q s,v0 Signature Telephone No. NOV-14-2004 10:02 AM KELLYCASEY 978 937 1816 P. 04 .Ni v COMMONWEALTH OF MASSACHUSETTS OF AS A REG jOSUQQLBNE,V%V,IANECTRYCIA , E6Ff �� KELLY M CASEYe 700 ROBBINS AVE UNIT 3 DRACUT MA 01026—5x6 37200 E 07/31/07 972730 NOV-14-2004 10:01 AM KELLYCASEY 978 937 1816 P. 03 */ @YATIONA.L GRANGE MUTUAL INSURED INSURANCE COMPANY 55 West Street,Keene NM 03431 TelephoAe:1.860849-f730 CONTRACTORS POLICY DECLARATIONS Named Insured and Mailing Address KELLY M CASEY Policy Number MPK69328 Account Number: CACK69328 700 ROSBINS AVE UNIT 3 DRACUT, NA 01826 Agent: BYETTE INS AGENCYP INC Producer Code: 200113 AGENT PHONE t 978 851 6678 POLICYHOLDER INFORMATION Named Insureds Business: ELECTRICAL WIRING Entity: INDIVIDUAL Policy Term: 12 Effective: 01/27/04 (12:01 A.M. Standard Time at the address Expiration: 01/27/05 of the Named Insured stated above) In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. See the attached schedules for Description of Premises, Property Coverage, Optional Coverages, Forms and Endorsements applying to this policy and Mortgagee Schedule if applicable. BUSINESSOWNERS LIABILITY COVERAGE LIMITS OF INSURANCE Liability & Medical Expenses- each occurrence S 300,000 Personal and Advertising injury Limit $ $001000 Products-Completed Operations Aggregate Limit 9 600,000 General Aggregate Limit 4 600,000 Fire Legal Liability - any one fire or explosion 1 5001000 Medical Expense Limit - per person # 10,000 Business Liability and Medical Expense: Except for Fire Legal Liability, each paid claim for the above cover- ages reduces the amount of insurance we provide during the applicable annual period. Please refer to section DA. of the Businessowners Liability Coverage Form. For policies subject to premium audit: Annual Audit Applies. Commercial Inland Marine Coverage Part g 65 Estimated Annual Premium: 4 589 TOTAL PREMIUM AND CHARGES 0 652 Countersigned: /-?// By "-5470(9100) 12/11/03 RENEWAL MC Date.... Y f HORTN 4 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 'SSACHUS Thiscertifies that ......... ............... ..............................,... .... ............... ` ./1.�1�.. /�. ,�I /- f. haspermission to perform ........... ............, .....Y... ...r..................I............. wiring in the building of.. . .!. )a. ...",M/a: ..................... at........... I ". .............................. :Y.� (.,North Andover,Mass. Fee r .. I`..... Lic.No.Z�Vf..`�.....................................� �. ....�.... ..., ... ELECTRICAL INSPE&6R Check # Commonwealth of Massach setts Official Use Only Department of Fire Se ces Permit No. 7 BOARD OF FIRE PREVENTION R GULATIONS Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance wi the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE A INFO TION) Date: City or Town of: F To theIn p r of Wires: By this application the undersigned gives notic of his or her intention to perform the electrical work described below. Location(Street&Number) V Owner or Tenant Telephone No. d Owner's Address � nQ� Is this permit in conjunction yvith a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building A-4 k &I Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Prop ed Electrical Work: �tf� cf- 1*Vr1e Ai4d Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o Emergency ig ►ng rnd. rnd, Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent p No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts f Devices or Equivalent No.Hydromassage Bathtubs No.of Motors . Total HP Telecommunications Wiring: No:of Devices or EQ uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) On File Feb/ 400/, (Expiration Date) Estimated Value of Electrical Work: k1 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I cert,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey Signature LIC.NO.: 37200 (If applicable,enter "exempt"in the license number line) Bus.Tel.No—978-6974453 Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Alt..Tel.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: $ �(J Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked r [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3-1.7-2006 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&.Number) 67Settlers Ridge Owner or Tenant Mary Casha Telephone No.978-314-8941 Owner's Address Same Is this permit in conjunction with a building permit? Yes No X (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps 7 - Volts -Overhead-❑ Undgrd - No:of Meters - Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace 3 fitures&other misc items for sale of home. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Fixtures 2 No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets 2 No.of Hot Tubs Generators KVA No.of Lighting Fixtures 2 Swimming Pool Above ❑ In- Elo.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches 4 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons _ No.of Waste Disposers Heat Pump Number. qn .......... KW o.oSelf-Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW SecurityNof steDevms s or Equivalent No.of Water KW No.of No.of Data Wiring: I Heaters Signs Ballasts No.of Devices or Equivalent No.H dromassa-e Bathtubs - o.ofMotors -_- Total HP Telecommunications Wiring:_ y g No.of Devices or E uivalent -- i OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) On File Feb/2007 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 3-16-2005 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Kelly M. Casey Signature LIC.NO.: 37200 (If applicable, enter "exempt"in the license number line) \ Bus.Tel.No.: 978-697-4453 4453 Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $25.00 Signature Telephone No. NOV-14-2004 10:00 AM KELLYCASEY 978 937 1816 P. 02 �► Commonwealth of Ms Chusetta Official Use Only f iDspartment of Fire, ervksa Permit No. L f r BOARD OF FIRE PREVENTION REGULATIONS Occupancy and pee Check ren 5'�.,/ 1It Rev, 1IN leave blank APPLICATION FOR PER IT TO PERFORM ELECTRICAL WORK All work to be performed in with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE AltN ORAUT70AP Date: t t_t y - Zcx�� _ City or Town of: Nvfuvz_ To the Inspector of Wires: By this application the undersign gives B of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant LAfit •k ._ Telephone No. Owner's Address `�� Is this permit in conjunction with a bullft permit? Yes ® No ❑ (Check Appropriate Doi) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd[] No.of Meters New Seryke Amps 1 Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A_t_ „� rka ,t a_s �^ C. etiair o rhe follow table=be waived by the Ins ctor of Wires No.of Recessed FirturesNo.of C*L-Suep.(Poddk)Few o.o r Total Trttasforman KVA No.of Lighting Outleb No.of Hot Tuba Generators KVA No.of Lighting Fixtures I Swimming Pool Above red. ❑ � ❑ o. Units Bey g No,of Receptacle Outlets No.of Oil Buser, FIRE ALARMS No,of Zones No.of Switches No.of Gas Damon NO.of Imection s ee La Initiatial Devices No.of Ranges No.of Air Cond. Tow No.of Alerting Devices Hat Pump unt lKWNO.Of sw-cootaluia No.of Waste Disposers Totab. ... ..ani.,..... ._.___.._........ RAK4,WWAlertim paDevice Na of Dishwashers Space/Ara Heating KW Local ❑ C nniee3i 1 ❑ Other No.of Dryers Heating Appliances KW Seearl Met No.o -roe or Equivalent W o star KW o.o o.o Dab WW Heaters s Ballasts f Devices or Eaulvellent No.Hydromassage Bathtubs No.of Motors Total HP a NaMPUB Devicest t. OW. t .. OTIIBR: . Attach additimal daall lfduired or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical,*o&may issue unless the licensee provides proof of liability Insurance Including"completed operation"coverage or its-substantial equivalent.'The underslgoed certifies that such coverap is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File -Few cac. (Exp cation Date) Estimated Value of Electrioai Work: (When required by municipal policy.) Work to Start:., tk— Inspections to be requested in accordance with MEC Rule 10,and upon completion. I cen*,ender the psho andphw1da of pv*q,llhm&e Mia on dib gppikeden is&w cried coxwkfew FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey —Signature LIC.NO.:37200 (If applicable,enter in the license number lira.) - Baia.Tel.Nϒ.697-+4453 Addrea: 700 Robbins Ave Unit 3 DriscuL Mm 0 1826 : .AIt:.Te1:No.= OWNER'S INSURANCE WAIVER: I ate aware that the Licensee doe not)rave the liability insurance Coverage normally \ required by law. By my signature below,i hereby waive this requirement. I am the(check one)Elowner owner's sent. g SiirreOwner/Agent Telephone No. PERMIT FEE.$ (a S,oo Commonwealth ofMassach setts Official Use Only _f Department of Fire Sery cps Permit No. BOARD OF FIRE PREVENTION R GULATIONS Occupancy and Fee Checked [Rev. 11/991 leave blank U APPLICATION FOR PERMIT,TO PERFORM ELECTRICAL WORK All work to be performed in accordance wi the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN 17VK OR TYPE AFO TION) Date: City or Town of: To the 1 spec or of Wires: By this application the undersigned gives notic of his or her intention to perform the electrical work described below. Location(Street&Number) S V Owner or Tenant 6kemEl I Telephone No. Cz 2 d Owner's Address "Shke Is this permit in conjunction with a building permit► Yes No ❑ (Check Appropriate Box) Purpose of Building O v yq Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps. / Volts Overhead❑ Undgrd ❑ No.of Meters a Number of Feeders and Ampacity Location and Nature of Prop ed Electrical Work: tff Completion ofthe-following table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ n- F-1 o.o Emergency ig mg rnd. rnd. Battery Units i No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers eat Pump Number Tons K o.of Self-Contained Totals: .... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Water o.oNo.of No.of Devices or Equivalent f Heaters KW Si ns Ballasts Data Wiring: DWof Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecowAmunications iring., No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) On File Feb/ 00/1 Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey Signature LIC.NO.: 37200 (If applicable,enter "exempt"in the license number line) Bus.Tel.No.; 978-6974453 Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Alt.Tel.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: $ �(J t J Commonwealth of Mass chusetts Official Use Only ki19Department of Fire rvices Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked -V. [Rev. 11/991 leave blank APPLICATION FOR PER 11 TO PERFORM ELECTRICAL WORK All work to be performed in accordan ith the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO TION) Date: /—/L —o S"' City or Town of: MO. To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant 4 Telephone No. (/A50 Owner's Address .41 4t, -- Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators K-VA No.of Lighting Fixtures Swimming fool Above ❑ - ❑ o.of Emergency Lightig rnd. rod. BatteEX Units No.of Receptacle Outlets /Q No.of Oil Turners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.of etection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump umber Tons o.0Self-Contam Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Ll Elunicipa EJ Other Local No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.o KW No.o No.of Data Wiring: Heaters Si ns Ballasts f Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP elecon�mumcations Wiring: Na of Devices or E uivalent OTHER: ��fv Attach additional detail if desired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) On File Feb/2<-w,5 Estimated Value of Electrical Work: �/J/' (When required by municipal policy.) (Expiration Date) Work to Start: /—/ Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete- FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey Signature — LIC.NO.:37200 (If applicable,enter "exempt"in the license number line) _Bus.Tel.No.,978-6974453 Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE.- $ v b 0 Signature Telephone No. 5 .