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Miscellaneous - 69 HEATH ROAD 4/30/2018
j 69 HEATH ROAD J210/060.A-0007'0000.0 I I Date......r.. '1 4 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING Hu This certifies that .e.1......... 4 ...........4,161 4�— ................ ...... ...... has permission to perform ....... ....................f 7***"* ..;�..... .......................... ......... wiring in the buildin of...... A.) at n ver,Mass. .... . .. ............ ... ... . No Fee, � Li c.No. ZQ .............................. L INSPECTOR Check.# 63o .,. Official Use Only � Commonwealth of Massachusetts Department of Fire Services Pernut No. Oocupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 9ro51 ease blame APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massa&usetts Electrical Code(NEC527 CMR 12.00 (PLEASE PRINT IN INK OR TYPEAL IN O ON) Date: / S City or Town of: To the Inspee r 61 Wires. By this application the undersigned jives notice of his or her i on to perform the electrical work described below. Location(Street&Number)_ Owner or Tenant EY' Sb h Telephone No. Owner's Address atm Is this permit In conjunction with a buildingit? Yes No ❑ (Check Appropriate Box) Purpose of Building 1�� Utility AuMortiadon No. Existing Service 700 Amps ZA/Z qO Vohs Overhead Undgrd❑ No.of Meters Now Service Amps ! Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: G�(,� /Ie rJ l°X i•��� 0�^ l+' 0 Completion of the ollowi table Ma be waived by the Ins ctor of Wires. No.of Recessed Luminaires v No.of CeiL-Sasp.(Paddle)Fans °•of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tabs Generators KVA Ulghtm No.of Luminaires Swimming Pool d.Above ❑ °- ❑ Ba UUnletnitsBattery ency d. No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Uletection an Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste rsHeat mp ..Number,. ons . __......._....._.KW NO.o to lued Dispose Totals• Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Connection a° Pa [I Other No.of Dryers Heating Appliances KW tY s' Na of Devices or Equivalent No.of Wider KW o.o o.of Data Wiring:HeatersI Sims Ballasts No.of Devices or Eavivalenit No.Hydromassage Bathtubs I No.of Motors Total HP Telecommunications of Devices or Eaulvalent OTHER: Anach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Elect 'cal Work: /pCJ�.°`� (When required by municipal policy.) Work to Start 4/4//_/!!r Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify,ander the paths and penalties ofPe ury,that the information on this appleadon is true and comp1m FIRM NAME: LIC.NO.: 17238A Licensee: Richard J. Arel Signatu LIC.NO.: 27514E (Ifapplieable,enter"exempt"in the license monber line.) Bus.Tel.No.;978-372-1601 Address: Alt.TeL No.:Q7R—gt17—?1 R7 i°Security System Contracror License required for this work;if applicable,ernes the license number here: 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)Q ownerQ owner's a ,ent. Owner/Agent Signature Telephone No. PERMIT FEE.S �3 r � T&ammmPmD q1P Nawffq Awe& . Depart�neratoft�arl'�.�4cc�� • . Office of Wa*a dons 600 Wasi Rion Skeet Boston.,MA 02111 VW-MaxgovIft ' Worker'Compensation bwaance A'idavlE: dexsfConfcaccfors&leddeiam<anbexq Apert lnfox�aaltion Please ease Frkt LggUft Name(ausln�.sslOrganonlfndx'videat): /Y,r t I / l '1'C /!�C AAd&ess: Czty/StateMyl/ " 1,2; L�� 3 _ Phone P Ar you an employer?Check the appropriate box: Type of project(required): 1. I am a exqlloyer with. ✓'l d•• ❑X am a general contractor 6. ❑New c6nstraction employees(full andforpat��rxte).e have Wredthe sub•••contra 2.[� listed on the attached sheet,t I am a sole proprietor or 7' n Remodeling �and'l�aveno-employees Thesesub-contractors have 8. [�Dexnolztion working forma in.any capacity. workers'comp.insurance. 9. ❑Building addition WO worlars'cwmp.1nommce, 5. []We are a covoraflon and its 10.E�fSloctd(xdwpm or ad#&om mF&ed.I officers have emmvised.1heir 3.El J amt a homeowmer 11RJng allwork right of exemption per Mt1L 11.[]Rla bftrepaim or additions mWselfi[No worlm ,comp. c.152,§1(4),and wehave no 12. Roofrepairs t employees.[No worlM s' insuran required. 1313.[]Other camp,insurance regoirad. 0 sPPaoent�dmb box#f mustako fill outtbs section below sbowiogtheir wbdms'compenssttonpoHay ioPormsaoD. '� iarneownerswhosubmitfihaffl&vitfadfo*gthlaiedglogailwor md@reaaMmoutsldecmtca*mmmtmft*answaffl&wktAoatmgmo& lcontraotarsthat chedctbisbox mot v0dodan0dltlonalsheettsbmingthanameoffbasffn4Dractorsandtbeirwofte00mpPORGYfif naflon. frun art employer ibafisprovwoag workers'con fazsadon wsurwweforrny employees Below fsthepofBcy aid,foB SOe 3rifo�rrnat�ton Insurance CoxnpmxyName:. tl l • d (l Policy#or 3e1-ins.LIG.#: .A a �P t/C� Bxpixaf3ortDa#e: •316116' . Job Site Address; l�9 �7� �� lCi[y/Statef7atp: /./Yy1�01'^' Attach a copy oftbe workers'compensationpolicydcclaration page(showing the policy number and expiration date). Failure to secure covemp.as xeViredunder Section 25A.ofMQL o.152 can lead to the imposition of crimbalPenalties of a fine up to$1,500.00 and/ox on ymw hVrlsonment;as well as"penalties in the form da STOP WORK ORDML and a.flue ofup to$250.00 a day against the violator. Be advised that a copy of this statemontmay be forwmdedto the Office of yavesUgations of the DTA.fox insurance coverage verification. X do hereby certxj�under tlpahas a�rcd penaes o erjur�gat the tPtfbrrnattorr provided above ft true and donee .G' 2homm �'7X j♦ y Offlelral case only. Do not WT&1w this area to be coarrpTe d by city or Am o• dal City or Town: PexmnMcense# Issuing.A,uthority(circle one): 1.Board ofHWth 2.BuildingDepaxtnnent 3.Cty/Town Clerk 4.Electrical bspector 5 Plumb nghVector 6.Other ` Coniadperson• Phone#: Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Paul &Amy Ferguson Property Address: 69 Heath Road Policy Number: HP2654457 Date/Cause of Loss: 3/11/2015, Water/Ice Dams File or Claim Number: 31748-M Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Mike Peterson On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Q 6113 Date../d NoarM TOWN OF NORTH ANDOVER p PERMIT FOR WIRING � � - IV SSACHUS� .. Timis certifies that . ......... ........ ....................................... has permission to perform wiring in the building of....... ,-' !����"' ''" ........................................... at.Ap ..... ..................North Andover,Mass. Fee-?I Lic.No OJ. ... ..... Check # ELECTRICALINSPETOR �� y,�� V ,,� MUMW NPOFPU MSUM Lftad.�tftaBAARDOFFZREPREVEVI1n�iVRB iVLA?hOl11fSS17C1 mizaFee Checked Now ct . APPLICATTONFOR PERMITTO PERFORM ELE CAL WORK ALL WO RK To BE PERFORMED IN ACCORDANCB WITH THB MASSACHUSSTS P1ECrRICAL COD ,S27 CMK 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) I�cf �Pa ST Owner or Tenant Owner's Address Is this permit in conjunction with a building pemlit: Yea J No [:3 (Check Appropriate Box) `11(,-43°1 Purpose of Building Utility Authorization No. Existing Service a�� Amps 20 111/0 old Overhead E3 Underground No.of Meters New Sett G Ampalaf G Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 7/) 41-1 Tr oil, L,,-A, i Na of Ugbdng oatku Na of Har Tuba No. Total KVA Na of UandnS Fit" 3 o Sw mtrtirrs Pool' Above Babes rJ ckrtmatan KVA Na of RwApuele Oudw O No.of 011 Burma No.of Emergency Ughting Baty units Na of Switeb OutWa 3 G No.ora..Boman No.of Raises Na of Air Gond. Taal FIRE ALARMS Na of Zeros Taos No.of Dispossh Na of Haat Taal Taal No.of Detaedon end Ton KW raidadng Device No.of Dishwuhm Space Area Headry KW Na of Sond6ts Devteu Na of Self Camahmd a No.of Dryer , Hearins Devices KW Lord Mmicipel Ochi . a C��n a No.of Water Neaten KW Na of Na of y Sims BWimb Na Hydro Mutap Tube Na of Moton Totd HP OTHER- 1rlstart�Co�es�Plsranrbliere4ierdecfMesdasel�t3almlLsttt ® � --- 1ha�eaaare3ttl�e6t�yhltstoeFt�f�yindudr�Clorr{ice oYM NO IhnesiftnkdvefdpWd(w IWDIv0MZ YMET I<yauhatepka;limthetypet#wmrby F trnrbdVAzcfEkc"Wak Ss WakIDSW iapatiortD*Re xAW Ra* Few urt�r Pa�tf E�MNANlE �� rvy �r t r U E"7 2C hr r L c L imaeNa 17-S SS A 1 �e AVIO—r1i 0 T llr- Budrtes UNa 9 -53/o-rXd7 116' (�""— `'T- �'�`�' l`7 G A LTUNa X 17 oZ�i3-(S S�S OWT,WSM1RANCEWANFRIanswa futeL mwddnnd amneao�eariltatrlayilequtvalmtasta}siedbyMealscfi�bGenaill (Please check one) Owner � Ageat Telephone No, FUS r-3 13 DfflJDM®I 0FRNXS*Wy B�AAIPDOFFIREPREVFN7MRBGM47Ig1 M7(�112� L 4,113 Feet Checked .� APPUCA71ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE VTM THE MASSACHUSM EI.E MXAL CODE,527 CMtt 12:00 (PLEASE PRINT IN INK OR TYPE ALL MRMATTON) Dai Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with.,&building permit; Yea® No a (Check A PPmPeuft Boa) Purpose of Building , , . yl(; Existing Service 0 Amps 2r o/ c% oltsOverhead Utility Authorization Underground No.of Meters New ServiceG Amps%� ; /21 O volts Overhead Underground No.of Meten Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 7—/) 6L Na of Lighting Outlets Na of Har Tubs No.of Trsnatbrraan TOW Na of Lighting R=m 3 Swimming Pool Above Bebw � KVA KVA Na of RwAPMb Oudeft Q No.of OB Bumn Vowed rril U1101111 Na of Emergency Lighting Battery Univ No.of Switch Outieb 3 No.of Go Bormn No.of Rattan No.of Air Cad TogaME AL ARMs Tpr � Na of Zama Na of Dispossle No.Of Hest Total Told No.d Deftdm and No.of DishwashersHee Ton W raideft Dr4jen Space,atm o.of Swoft Dervien Na of Sdf CoataindW No.of Dryers Heating Dsvioes Key Lc Delecd-3am im Devices -- No.of Water Heaters Kw Ne,Of of Commtion 0[M Mzicipd Other SIDE Balls* j Na Hydro Mausge Tube Na of Mom Ta1a1 H► OTHER, �k ixasarnet..otatrgz Anr�stbfEe�irirQidlldaeadl�QQgdI�rYt Iha�eaaatetlirh�ylnanwroeRtYincirdrBCbmplits�e�rs ar�s>tetsayeQ;�a � y II sutrrrillydvafdpr dst�dfre0l�Y$9 ® lfyoulatedtndoDdYH4�it d �[3 On= Ra* E�rrebdvalre WadcbS�tt lrgpecfbrDireRex�,e�d Roup dF1z**WadrS �SiBradui��iePtrratlisdpnjtsy. � i� i MNAM v--- IzeNn _ !7S S S ,� grow Ulm [� `I ?VTIMSII'13URAIKEWAIVFR,IaniawMOutlieiimtie diersiasrn�e AtTMNa IdirtrrryiBwkge�d�l vNlitedirequiremet �w�a Wain �dbYA'�cfsartbGertastlLawrs ease check one) Owner C3 Apo 1113M Or Uwn1r-VTM Telephone No, oEIt11QI,Fi3E g '73 �i— a 7-0 �J O,b Date.................................. O� NO DTM 1h TOWN OF NORTH ANDOVER a 1 _ ' PERMIT FOR WIRING ^cMusEth This certifies that ..........................................!..<<% : ........ ............. has permission to perform ... - � ^ .r.;.'.....:tr:................................ . wiring in the building of at............. � . ..� ...... �:..............-,North Andover,Mass. Fee-31..r....'`�Lic.No ...... * .. . !l :sr. . . ELECTRICALINSPEE7OR Check # t 6555 Department of Fire Services Permit No. GS S BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked °yam [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PEFORM ELECTRICAL WORK All work to be performed in accordance with the Massachu tts Electrical Code(NEC) 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: ('>y, To the Inspector of Wires: By this application the undersigned gives notice of his or her inten n to perform the electrical work described below. Location(Street& Nu ber) 0 Owner or Tenant (,Lt! ( use-vt Telephone No. SLS {�,i.� 77j7 Owner's Address J-',K}Im57 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building ` m g �25.{'ck�tom--- 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: t<� Vo ffi Ce Wf Aix Completion of thefollowing table m be waived b the Inspector o Wires. No.of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No.of ofal Transformers KVA No. of Lighting Outlets No.of-Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ n- ❑ o.o mergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of Detection an No. of Switches No.of Gas Burners o. Initiatin Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices catump um er ons o.oSelf-Contained p No.of Waste Disposers Totals: Detection/Alertin Devices No.of Dishwashers S ace/Area Heating KW Local ❑ unrecti El Other P� g Connection No.of Dryers Heating Appliances KW ystems: �' NoNo..of Devices or Equivalent No.of Water KW oo o.o Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP a ecommumcat�ons inng: No.of Devices or E uivalent OTHER: TV S 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 ❑ $t1ND ❑ OT R -❑ (Specify-) (Expiration Date) Estimated Value of El trical Work: (When required by municipal policy.) Work to Start:,3 a t6 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under hep 'ns and penalties ojperjury,that the information on this application is true and complete FIRM NAME: S 7 t LIC.NO.: Licensee: I�X ewt P Signature LIC.NO.:— (If O.: ! (IJapplicable,enter "exempt"in the license number line.) Bus.TCI.No.• -3 to 'f3E Address: �4 q L-4 fni 1p-GQ wesi-6w q d l aG Alt.Tel. OWNER'S INSURANCE WAIVER: I am aware that 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. ••W�fA MIA(fPT� 4 t�� ��.: ��� � � o 1 ��� f 1 r c a B & B Er.gineered Timber Robert L. ("Ben") Brungraber, Ph.D., P.E. 42 Hurricane Road Keene,NH 03431 19.Jan-06 Gerald A. Brown, Inspector of Buildings 400 Osgood Street North Andover, MA 01845 Re: Ferguson Residence; 69 Heath Road Dear Mr. Brown: I am the engineer-of-record for the remodeling work being done to the Ferguson residence at 69 Heath Road. I have long specialized in exposed heavy timber framing, similar to the superstructure in the new Ferguson great room. I have inspected the site twice, during construction; most recently on 17JAN06. The builder is doing a very thorough and professional job. I hereby certify that the project is being installed with the materials,per the stamped drawings. I am enclosing a set of the structural drawings for the project,making more specific the various engineered beams and headers used in the framing. �. I have inspected a lot of buildings,but the original Ferguson home remains unique in my experience. The combination of steel, timber, and concrete—in a single family home—is nearly a political statement on construction methods. Do you think that there is any chance that your office has a copy of the original construction documents? I have been keeping abreast of site developments, as we tie into the existing structure, because we only know for certain what is available after having exposed the original structure. I hope that this has addressed any concerns that you may have about how this project is being handled. Please do not hesitate to reach me, should you have further questions. Yours, ��P�SN OF bqs� �' �c l ! ROBERT 1 � BRUNGRABER � R.L. Brungrab r �NoCI II.isr y ' :��<". Enclosure ,SFis r<; S�ONAL ENG XC:Howell Design&Build,Inc. Robert L. 'Ben"Brungraber, Ph.D., P.E. ENGINEER,WORRIER BENSON WOODWORKING ARCHITECTURE and TIMBER FRAMING ENGINEERING ben@bensonwood.com.www.bensonwood.com 6 Blackjack Crossing,Walpole,NH 03608 603/756-3600.Fax 603/756-3200 i B & B Engineered Timber Robert L. ("Ben") Brungraber, Ph.D., P.E. 42 Hurricane Road Keene, NH 03431 19-Jan-06 Gerald A. Brown, Inspector of Buildings 400 Osgood Street North Andover, MA 01845 Re: Ferguson Residence; 69 Heath Road Dear Mr. Brown: I am the engineer-of-record for the remodeling work being done to the Ferguson residence at 69 Heath Road. I have long specialized in exposed heavy timber framing, similar to the superstructure in the new Ferguson great room. I have inspected the site twice, during construction; most recently on 17JAN06. The builder is doing a very thorough and professional job. I hereby certify that the project is being installed with the materials,per the stamped drawings. I am enclosing a set of the ' structural drawings for the project, making mores specific the various en peered be s and headers used in the framing. I have inspected a lot of buildings,but the original Ferguson home remains unique in my experience. The combination of steel, timber, and concrete—in a single family home—is nearly a political tical statement on construction methods. Do you think that there is any our office has a copy chance that Y of the original construction documents? I have been keeping abreast of site developments, as we tie into the existing structure,because we only know for certain what is available after having exposed the original structure. I hope that this has addressed any concerns that you may have about how this project is being handled. Please do not hesitate to reach me, should you have further questions. Yours, r 4 OF 4fhSf ROBERT Lcy'c 4 ' BRUiNGRASER\ CIViL R.L. Brungrab r i No. 34IS7 y �rVED J Enclosure JAN 2 n �QQ NAL XC:Howell Design&Build,Inc. 13vILDI1V G pEPT Date "oaT„ TOWN OF NORTH ANDOVER x PERMIT FOR PLUMBING Y z�cMUSE� This certifies that . . .l . . .t 17. . . ... . . . . . . . . . . . . . . . . . . has permission to perform . . . c c 4.6q ���.�. . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .r.5 .t3 .7.�.Y4...... . . . . . . . . . . . . . . . . . t at . . . . . . . . . . . . . . . . . North Andover, Mass. , Fee-3?3.�. .Lic. No.��.�?.`!. . s f PLUMBING INSPECTOR j Check # 6671 71 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Ty") All)- Avi —oye-_n., Mass. Date 19_ Pemtit# T Building Location ,CI � �. tZ Owner's Name Ae ir Q use,in, _ Type of Occupancy New O Renovation O Replacement CDol' Plans Submitted: Yes❑ No O FIXTURES z z rn – O N O O Z Z W to 19 rA J Q O Z N < � .S ~ O z G x y d O O N W h I- W il a M iiV W W 0 < O W x d z '�. I- V O b M W } < ~ a z o < W O C 4 Z O Ib C W v '. W y W C ? J O C J = O C O 1V G O Z d x y h Z O O M = Z .W sus—BSMT. BASEMENT j IST FLOOR 2ND FLOOR y 2RD FLOOR 4TH FLOOR STH FLOOR eTH FLOOR 7TH FLOOR OTH FLOOR Installing Company Name Check one:. Certificate Address 1_ 7— 0-arporation bIL11 61 faf 177- ❑ Partnership Business Telephone ;�© Flffn/Co• Name of Licensed Plumber ccz In 44 INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142: Yes No O If you have checked yn, please indicate the type coverage by checking the appropriate box A liability Insurance policy ❑ Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have- the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this pemtlt application waives this requirement. Check one: Owner O Agent❑ Signature of Owner or Owner a t 1 hereby certify that all of tin details and information 1 have submitted(or entered)in above application.are true and accurate to the best of my b MAedge.and that all plumbing work and installations pert under pe sued for tion win be in compliance with all pertinent provisions of the Massachusetts State PlumtH and 1 Ge gnature o umbeF Title Type of License:Masters(-' Journeyman❑ �ptyyF�j�FF(t:E�O�E�RCY�'-- . Ucense Number Location No. 3o Date "� 01 NORTH TOWN OF NORTH ANDOVER F p s ; ; Certificate of Occupancy $ 41 sAGMUSEt� Building/Frame Permit Fee $ — a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i84A U Building Inspe,rV C f TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT RLP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 30 DATE ISSUED: rn 3 SIGNATURE: Ge/�? Building Commissioner or of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number. G9 NEArH APTH Ana A Map Number Parcel Num ber 1.3 Zoning Information: Q/ 1.4 Property Dimensions: R7 SINGLE �IIN 9010kf-''7AL 172, *� Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided ReqWred Provided p 4 C;?p -r a 1.7 Water SupplyM.GL.C.40. 34) 1.3. Flood Zane Information: 1.8 SDisposal System Public Private ❑ Zane ew Outside Flood Zone ❑ Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSE[IP/AUTHORIZED AGENT %I IC% UIStri Ct: 2.1 Owner of Record y PAL. 4 Amy Fmusoo Name(Print) Address for Service Signature Telephone 2.2 Owner-of Record: V Name Print Address for Service: Z Si azure Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed C/onstrruccti'on, Supervisor: Not Applicable ❑ a L. 1' &UVM �S 5f�� /� Licensed Construction Supervisor: 1 0 39 5j4qXjUWA J� I ��( MA 0�53L License Number Ad/dress qA" Expiration Date g ature Telephone r w 3.2 Registered Home Improvement Contractor Not Applicable ❑ v RL OEe.I&A) $ ,o 123297 Company Name 6/ l'IER I MACK STRM � /AWR� ,ry►, 01$y� Registration Number r Address ` /,Wr / /D ZCO f'v 9��9 9yya Expiration Date /� nature Telephone Y' SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes....... No.......0 SECTION 5 Description of Pro sed Work check ad a ble New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition X Other ❑ Specify Brief Description of Proposed Work: 2-51V" Awill-o 9t Exrevsin,o cc Krrzrte/0 4 MAsw-k Sur i Aaan4., pC AJJmoy ar Z- CAS &M41-F, LAyrUOlcY I&M Pawa�e Joon wff?f aeSr Some rr r�6ot� -au o,- vNHvr,C S"eEu Ro.�, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL.USE ONLY Com leted b rmit applicant 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of / Construction oZ vs� 6 a s 3 Plumbing Building Permit fee(a)x tbl 4 Mechanical HVAC C/� Q 5 Fire Protection 6 Total 1+2+3+4+5 oZ S`_J 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 to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I,_ _Z f71✓"GyL2M4� of /Xe�t �EIrBv d'/�xcp ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief /�yM.EI3 L, �%/GFf�NA..r ��tc. /✓�'.Tr�v � !N��, Print N Si ture of();ZeriAg6f Date NO. OF STORIES SIZE BASEMENT OR SLAB s SIZE OF FLOOR TIIABERS 1 2ND 3Ku SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GMDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X — MATERIAL OF CH &4EY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM -V INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT t b� "o �� PHONEMV-�Yyv LOCATION: Assessor's Map Number-� PARCEL- SUBDIVISIONAIN`�� LOT(S) 1 ,�QQ STREET 'LOQ- 3T. NUMBER_ OFFICIAL USE ONLY RECO DATIO FT ENTS: CC NSERVA ION ADMINIST TOR DATE APPROVED In DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS p PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVE W Y PE IT FIRE DEPARTMENT 7- o s� DUMPSTER PERMIT RECEIVED BY BUILDING INSPECTOR DATE FORM U-Revised 6.05 JMC 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 at: 6 9 kkArH Co is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility /fie �z � Si azure of Permit Applicant Fire Department Sign off Dumpster Permit Date i C � the (;ommonwealth of Massachusetts Department of Industrial Accidents RT Office of Investigations d 600 Washington Street a Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p Please Print Legibly �Le,&C Name (Business/Organization/Individual): 6fSi't,,.d 9 1Jt,/'�D Address: 3�� M � S;�€�r &("I G 4157 City/State/Zip: C-A.,< 1�?A otm Phone Are you an employer?Check the appropriate box: Type of project(required): 1.5 I am a employer with I_�__ 4. 1�<I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 ?• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. C. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.0Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information, I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �1,�- Insurance Company Name: f'�I tv -o _ TA/(0 aA�-,,C46 — " 1110CA41 Policy#or Self-ins. Liic. #: SSA6H(o&3j Expiration Date: Job Site Address:_ / p , City/State/Zip: /6V A4>,01 (orf OI f 1S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-yearmprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Xrtlfythe p i nd nal ties of perjury that the information provided above is true and correct Si ature: ��J At- At tyts Date: t05, Phone - Oficial use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires`all emplo ergs n in theservice of another under any conetracto provie workers, compensation for thir t of hire ' Pursuant w this statute, an employee is defined as �Y P express or implied,oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged in a Joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of au individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more-three apartments a�nancenconstructiond who eorthrepair,or the wo k on such ant of the dw ling house dwelling house of another who employs p ant thereto shall not because of such employment be deemed to be an employer." or on the grounds or building appurten MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or operate a business or to construct buildings in the commonwealth for any renewal of a license or permit to ence of compliance with the insurance coverage required." applicant who has not produced acceptable evid Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to cant'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 ccidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should A Areturned to the city or town that the application for the permit or license is being requested, not the Department of be Industrial Accidents. Should you hive any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ffidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant of the a Please ff sure to fill in the perut/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bur leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia &Ordwof Buil ing Regula ons and tan ar s One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 123237 Type: Public Corporation Expiration: 1/10/2007 HOWELL DESIGN & BUILD STEPHEN HOWELL 360 MERRIMACK ST. LAWRENCE, MA 01843 Update Address and return card.Mark reason for change. Address F Renewal F] Employment Lost Card )PS-CAI Co 50M-04/04-G101216 7!e C�omimoruueai a�./�aaaac/zuaeka Board of Building Regulations and Standards License or registration valid for individul use only -- HOME IMPROVEMENT CONTRACTOR. before the expiration date. If found return to: Registration: 123237 Board of Building Regulations and Standards Expiration: 1/10/2007 One Ashburton Place Rm 1301 Type: Public Corporation Boston,Ma.02108 HOWELL DESIGN&BUILD STEPHEN HOWELL 360 MERRIMACK ST. LAWRENCE, MA 01843 Administrator Not valid without signature s . � �ax�.'�,o, ✓�ie 1!nomv�nanrt�� olJ..��,aticacllrcee��d 1 BOARD OF BUILDING REGULATIONS I License: CONSTRUCTION SUPERVISOR Number: CS 085176 Birthdate: 04/01/1976 i Expires: 04/01/2007 Tr.no: 85176 Restricted: 00 THOMAS L HEFFERNAN 399 SHOREWOOD DR 'FALMOUTH, MA 02536 Administrator I to ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J (effective 3/1/98) Applicant Name: N0W1E e5hvJ 6 60LvT+C_ Site Address: 69 ` ft 64O Applicant Address: 3kO MUOMAeK Sr City/Town: o N, MwAelw MA 01�'6 Use Group: Date of Applican: _ 1 p Atio pplicant Phone: 979 2F9-�yyp Applicant Signature: Compliance Path (check one): [] Prescriptive Package (Limited to 1- or 2-family wood frame buildings heated with fossil fuels only) Package (A duough.KK from Table J5.2.1b): Heating Degree Days (HDD,;) f,•om Table J5 2 1a: (For items d. through i., fill in all values that apply from Table J5.2.1b:) a. Gross Wall Area sq.ft f. Wall R-value R- b. Glazing Area' sq.ft. g. Floor R-value R- c. Glazing% (100 z b-a) % h. Basement wall R- d. Glazing U-value U- i. Slab Perimeter R- e. Ceiling R-value R- j. Heating AFUE f7 Component Performance: "Manual Trade-Ofl" (Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.2.2) [] Zone 12 [] Zone 13 [] Zone 14 Anach Trade-Off Worksheet from Appendix 1, [and HYAC Trade-Off Forksheet, if applicable] r7 MflScheck Software Anzch Compliance Report and Inspection.Checklist printouts. 7 Systems Analysis . OR [] Renewable Energy Sources Anzch Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR A.DDITIONS.ONLY: a. Cross Wall + Ceiling Arca 57S9 sq.ft. b. Glazing Area' 6y0 sq.ft. c. Glazing % (100 x b+a) /M7% ADDITION with Glazing % (c.) up to 40% may use 780 CMR Table J1.1.2.3.1 below: yt.tX1MUM U-value MINIMUM R-Values Fenauatioa ceiling-1 Wall I Floor Basement Will Slab Perimeter, Depth 0.39 R-37 R-13 R-19 R-10 R-i0,4 ft Cl "SUNROOM" addition (greater than 40% glazing-to-wall and ceiling gross area) attach "Consumer Information Form" from 780 CMR Appendix B. Official's Name: Official's Signature: Application Approved 0 Denied Date of ApprovaUDenial: Reason(s) for Denial: (provide additional details as needed on back side) Glazing Arca may be either Rough Opcning or Unit dimensions. BBRS 06/17/98 NORTIy TOIWM Of over No. O ...q.wm, ��4•, •.?y D = A E dover, Mass., � " � 3 m COCKICMEWICK V ORATED PS S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System A we BUILDING INSPECTOR THIS CERTIFIES THAT ��...............................v, .. v=�~ .... ......... ....... .............. .........,...................................................................... Foundation has permission to erect.... `S �.......... buildings on ` N.'�� ��............... Rough r.......... ................... Q 0� � �r� K • �� hh Chimney to be occupied as 0 �K S R 1. 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 CiQnstruction of Buildings in the Town of North Andover. 4w V#44r%1( t#.Vk j I&**"M i 6 bo&* 3•#}10/SYN f4WA PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. G 1041q Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIO ST TS ELECTRICAL INSPECTOR Rough ...... .... ... .............................�................................................... ervice BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. N0 2471 Date..../ ............. ..... Of NORT:.+,t,, or O� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 41 •A— �'SSACHU`�� This certifies that' " has permission to perform ............................................................................... wiring in the building of .............................................. at.. ... .............'��... .................... ......... ,North Andover,Mass. Fee.�n...�...... Lic.No.11174!��'.........:�.`A ! .............................. . ...... . Check # ELECTRICAL INSPECTOR V� r r WHITE: Applicant CANARY: Building Dept. PINK:Treasurer AAAA,th/1FALVlVLYf'TA-tA.AIA Alill 111[7U:,9!'F�„4{',Vi9ti2Ik3 DLPA TAfE 0FPUBLICS4FM Permit No. 7� BOARD OFFIREPREVEMONRF_GUL4770AS5270f)?12.00 Occupancy&Fees Checked APPLICATION FOR PERMT TO PERFORM ELFCMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date�r7 D—.�oD ..® Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 66j Owner or Tenant /Yl Ft k fJ Sal A Owner's Address Is this permit in conjunction with a building permit: Yes 12 No (Check Appropriate Box) Purpose of Building Utility Authorization No. — Existing Service Amps / Volts Overhead ® Underground ® No.of Meters New Service Amps / Volts Overhead ® Underground ® No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work w 5,P =227 67-17- egg TVF,5 No.of Lighting Outlets /_ No.of Hot Tubs No.of Transformers Total G� KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and ound No.of Receptacle Outlets ` No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch @92M No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal ® Other Connections No of Water Heaters KW No.of No.of _ Signs Bailasis ' Nu.Hydro Massage Tubs No.of Motors Total HP OTHER Inst XCCo�aage Rffa'antl;,them mar2ttsdMassad�G=3alLam IhaNeawautLiabli h PetxymdudmgCm Comageertsstkst3tdeg valet YESE�r' NO Iahha�wswti>bmttadvalid p�ofsmneiothe0�YES (El ® Ifjouhmed� SYE ,pkmemk&thetypeof'om� by�gthe NSURANCE BOND OTHER ® ftwe-Spe*) E?gm-zaial D* M Wcikio tart0A4 t/Nney) O a0� h>Spe�D&Rtsed �, FM Estrnm civahte trialWaic$ a; ° d utxler�ie FiQiM NAME lip Q✓ �L��T, / rI L Ii�seNa �L4 LimkvL te�n lE toy T�® o--� Lia�eNo �4 3 r9 Bm=TdNlo 2Z YY g�SS�►4 � yAiTe1Na OWNR'SNLRANCEWANER;Iammmhaftlxsrd aLam � and�my ssemths ptm� on wanes this racluaena>;. (Please check one) Owner Agent Telephone No. PERMIT FEE$ Date.1Z.Av• . N° 4 4 i 8 { TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING o ,SSACNUS� This certifies that . ` 'r° r•:% �. •`•.1 nom/... • • • • • • • • a has permission to perform . . . . ... .�` `� t''. • . . . plumbing in the buildings of . . . . . . . . . . . . . . . • • . . at .1�.` . . . .� . . . . . . . . . . . . . North Andover, Mass. Fee °T. . . .Lic. No. 40;17. . 4 C.,. . . . . . . . . . �J�r e . PLUMBING INSPECTOR Check # / WHITE: Applicant CANARY: Building Dept. PINK:Treasurer r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /� , /� / Date Building Location (� /`? 4-/ Owners Name ��irli'J�� Pe t# W Wit ount /ems G-a T e of Occu an New Renovation Replacement PI s Su ed Yes No FIXTURES w a 9 V. acr �; F A Q FCC E• fs+ W fs, Z 0" F Q a Q Q H S[BBgVIC BASEW YI' M RUR l f M FLOOR C 1 -IM HIM I 4M FlaR 5fflH m s>�itH�x 7MROCR s>H HfM Id (Print or type) / / Check one: Certificate Installing Company Name Corp. r�3v2� C Address e- / 2�. El Partner. Q ' - 636 Business Telephone - - O gG Firm/Co. 6 Name of Licensed Plumber: P2� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: q Liability insurance policy Other type of indemnity ❑ Bond ❑ 's Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner F1 Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S Code and Chapter 142 of the General Laws. -- .c By: igna o kens um er Type of Plumbing License Title f142 City/Town icense Numoer Master I 1- JOumeyman APPROVED(OFFICE USE ONLY u i Location Ile(IJ// �-vl No. Date 6_11(,_ 6'0 NORT1y TOWN OF NORTH ANDOVER f � 1O p Certificate of Occupancy $ •�,S t�'a Building/Frame Permit Fee $ X179 +� S�cNusE h Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� Check # 1 3 ( 0 4 Building Inspector r r• TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR.RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ::.w.._. =SIS S O4.fOP OICIAIE Use VIII BUII.DING PERMIT NUMBER: �8/ DATE ISSUED. SIGNATURE: Building Commissionerfl or of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 AssessorsMap and Parcel Number: 46v�?0ne1 6 CA `�7 R� / , 07` J / Map Number Parcel Number �� a2�� 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr000so3 Use Lot Area(sf) Frontage(ft) 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Re 'red Provided v 1.7 water Supply N.G.L.C.40.5 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal ❑ on Site Disposal System 0 _J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address f Service 7d Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 7 Sienature Telephone 1 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Not Applicable ❑ _/ t l LicenX'l Construction 9upervisor es G O License Number Wn ' Address .�/30/P > Eatpiratio Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name rn Registration Number Address Xa� ExpirationSL r1 Se Telephone Y SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building 0 Repair(s) 0 Alterations(s) ❑ Addition 0 Accessory Bldg. 0 Demolition 0 Other Specify ,e Brief Description of Proposed Work: �r� Svz d �✓ /� SECTIO 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building I (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit tee(a) x (b) 02 4 Mechanical(HVAC) 314 5 Fire Protection 6 Total (1+2+3+4+5) 0z) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Herebv authorize to act on My behalf.in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief / Print Name Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIv1BERS 1 2ND3KD SPAN DIN ENSIONS OF SILLS DIIvv1ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS DUMDING CONNECTED TO NATURAL GAS LINE I — `-- --------- ----- -z-V -r. r� --- - ---- - �A •rs (c\ 'a 07 TDON�MOw1 (I►G� ll�I�dl NONE IMPROVEMENT CONTRACTOR I License or registration valid for individual -Aeglst>atlon 106817 `use.only before expiration date. If found i{" ' � PRIVATE '- f (, t "t Ype I TE CORPORATION return to:One Ashburton Place Rm 1301 Boston Ma.02.108 E ) BLACKOOG BUILDERS, INC AV D K. BRTAN i� Ao rtlslanro 11Y Rd' I Sale1 NN 03679 00-35,000 cf enclosed space (MGL C.112 S.601.) -...._ ...� w. -...� to-Masonry only T ._ 1G-1&2 Family Homes ��ie �anz»caruue a�� �Gaalac`uwvll Failure to possess a current edition of the BOARD OF BUILDING REGULATIONS Massachusetts State Building Code License: CONSTRUCTION SUPERVISOR is cause for revocation of this license. Number: CS 048847 Birthdate: 08/30/1964 Expires: 08/30/2001 Tr.no: 3112 Restricted To: 1G DIG SAFE CALL CENTER: (888)344-7233 DAVID K BRYAN 5 KELLY RD#2 �' ! SALEM, NH 03079 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers'Compensation Insurance Affidavit Please Print Name: / v^ S Location: City 1 fi'/e11�7 ��1�� D 30 79 Phone �0 3 p?y� �1 am a homeowner performing all work myself. �— I 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. Company name: -Zl c k:fe o C Address (i City' 1���c�yl � , C �� Phone#: &w- Yw- or,-,y Insurance Co. '-F,r ` ' PolicV# Company name: Address City: Phone#: Insurance Co Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 herby certify under the pains and penalties of , 'uy that the i rmation provided above is true and correct � Signature / Date Print namePhone Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION No oTN Town of North Andover o� 64 , .6 0 0 Building Department o 27 Charles Street 4( _ North Andover, Massachusetts 01845 ' (978) 688-9545 Fax (978) 688-9542 9OpR`�""'"Pa " y 4 SSACHUS� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# 02 F1—CIC' the debris resulting from the 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/at: Facility ocati ,2'Lz'�' Signature of Applicant GIZK Z422 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. NORTH Town of Andover No. T OIC o dower, Mass., d COC MIC ME WICK � AoRATED P' Cl S BOARD OF HEALTH PER.. MIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... ..... .V.'... .. F�r ,�..0.. .......... Foundation has permission to erect..... �.. buildings on ...... ..�t....N+ !Z. ......R.4.0.................. Rough to be occupied as.........3........��. .�.�o.�.�A....1�....��p�..`.*i�....���lQ�1f�A�e1� 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 relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. #% ' PLUMBING INSPECTOR �o Jg P 7 �a'79�dou VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTT N ST TS ELECTRICAL INSPECTOR Rough ...... ......... ............................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. DR i VER, MA ' I` "' APIPLICA-1510N v,a Z IV ITT") B 0 om,Io I o%�"N E.R S!I I I, DATE BOOK PAGE 60d I.M.N0. 2. It , SULIDIV. LM No . 6 JIIJHJI(:SSt,( 13011 DIM;c) � !I S I J.;\I t. No . (;.s IORIFS SIZE '1144 PY,'Nl WS ADIMESS BASItINIUN I OR SI,AB I it7: 111�14_11r_�l adoli S!7J:(X:I I OOR 71 IMBERS ST 2 1,41) 3 R -Z/j g�r zj,/ "6 ble, SPAN _ DlIlIFNSI(94S Of SII.I.s R,lM,S 1"IFL; i m."ItaNslot'is(N:Ilos I S I Of i lN-S-SIDES REAR J)J.\JF Nz;()NS On GIRDERS LOT FRONTAGE i F:iGi 1-1 04-F(A)NDA HON THICKNESS slzil(y i(X)iING x N A 1A I!U-1 M A I I i R I Al.OF CI I I M N 1:Y 4 IS FILA IDI'lG,C -1)LAND ON )N SCXAD OR Fit I r S Bi A1.1!-RAT' /I//Y-'1 2zy 1,fe 14" Z�a�S"Sw MI i3ti11 DING CO3NF(XZoA TO RE(,�!I REN11-N I S OF CODEIS M Ill DI N(,CC.NNECI 1:1) 10 1 OWN WATER Ell V E<; 'N7 A1111L At-S ACI I G.14. IF ANY IS 1.'I I!I.DI No C(NNNEC!U) IO I(MT4 SE'Ali:R z eo IS 13(111 DING CONN F C I E1) 1-0 NA*l URAL.At.GAS I 1N: C,,N S J. 0; LA PZ FY IN F0 RA I A 110 N )s I ESI. 131.IX3-C(1o. i'('i 1,YNS I-3 EST. 1311X',. COS I PLR SQ. Fr. FST. 1.31 DG.COSI PER R(XXl C v I-i 1:RS Nit IST 3E ON Ot I I SIDE OF PU!I-!'q NG SEPTIC PERMIT NO. Ml,'STCONFORM MSFATEHRE Rt:(;t)l AiiONS 14. Avl'lzovl.l) 1!),: DING :"AIF i 11 1:1) OWNER—S]1:1.9 ('()?-I I R-11:1 Hj 6 CON I-R.I.R, ('AVNI:R("R Al J!11( II- s Location No. C>? " Date NORTp TOWN, OF NORTH ANDOVER 0� ..•o r•1ti 3? � . .• O0 ` Certificate of Occupancy $ sACMUS t� Building/Frame Permit Fee $ -3 b Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 13 r 5 Building Inspector .n N APPLICATION F01Z 11ERM IT TO BUlLD********N0R-rl-1 ANDOVER, MA L0I.NO- 2. Ii E:((MID,01-OWNE.RSHIP DATE BOOK PAGE Still.DIV. LM No . PURIX)SH OF BUILDING ;3� , /" No . OA:S rOMES WE OINNI-R'S NAME BASEN OR SLAB (AYNER'S ADDRESS IENl ST NDD aR(I111-( 'S"NAME SIZI:Or J:I.CX-)R'FIMBERS 2 3 SPAN DIMENSIONS OF S11-1 S DIMENSIONS OF F`0(S'I S :):S ANCE I ROM Sl REI:F )iS!ANCEi-Ra".il.OTLINES-SIDES REAR DWENSIONS OF GIRDERS AR:A OF I.Or FRONTAGE HLIGI FF OF FOLINDATION T1 IICKNESS SIZEOF I( (Y-'.INC, x ;s 8t;U-UN(;Nj, W WA-i ERIAL OF CHIMNEY MM-DING A:)!)i FION 4L IS BtjII-I)Il4(',ON SOLIDOR FILLEDLANI IS BIJUDIN6 Al--"f-RAT:ON -ER Is BUILDINCYCONNECTED 10]OWN WAI Is BUILDING CONNECILD TO'IOWN SEWER BOARD OF APPEALS ACFIC)N� IF ANY x IS BUILDING CONNECTED TONAlURALGAS LINF. O !,NS iCTIONs 3. pZOPERTYINFOWNIATION LAND COST ESI, Bl.[X;-COS i I'll 1.0A i IONS 1-3 EST. BLIXI.COSI ITR So. Fl, ES'l. 81 1)(;.COS I PER W"I EI t-�C-I-RIC METERS ERS MUS F BE ON OU"I SIDE OF BUILDING SEPTIC PERMIT NO. ------------ AF)ACHED(3ARAGESMUST CONFORM FOSrATEFIRE RL(;UI.AH0NS 4. AITRON'll) iil': PLANSI`,4USl, HE AND APPROVEDBY FHII.D!NG,INSITCF(N? BUILDING INSPF"'TOR ,)A It:1:11 1:1) OWNEP-S'l I-A CON FR.1 H.# CON I R.1,1 164 f7- OWNLRORAMM) IL) ----------- 19 r Restricted To: 1G E . 'License or registration valid for individual 00 - None use only before expiration date. If found j 1A - Masonry only return to: One Ashburton Place Rm 1301 { 16 - 1 6 2 Family Homes Boston Ma.02108 Failure to possess a current edition of the s j Massachusetts State Building Code is cause for revocation of this license. ' 4 r (i2w O�e1 // i 1 ✓lte L!'61N.1)tO)1ll�Clllflt (�/.."��QJJIJMfI.:P�: NOME IMPROVEMENT CONTRACTOR DEPARTMENT OF PUBLIC SAFETY Registration 106811 CONSTRUCTION SUPERVISOR LICENSE Type - PRIVATE CORPORATION lumber: Expires: Birthdate: Expiration 01/28/00 CS 118841 18/31/1999 16/31/1961 BLACKDO6 BUILDERS, INC Restricted To: 16 �jJ 9 ffneDAVID K BRYAN D K. BRYAN G� ANAN'S�OR ellr Rd 7f qtr✓ Selea NH 0107a 5 GEtiY RC 1: The Commonwealth of Pfassach usetts Department of Industrial Accidents 0lflc8v/lvyestlgatJons .. . 600 Washington Street Boston,Mass. 02111 Worke cessation rs Comp Insurance Affidavit �bc,�)e, - e 03 4 u V r-OT6'� ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compo anon for my employees working on this job. .. ....v; : .. ..:..:,..Y.. ::.::.; . . : ...:.. . .: utyI. • G ::.;.. nsur:ttice co. - ..:�1:- -.,.'T. '�'. — - -- .�T!'.T- - rf�TR�^Sr4�•1�C"�F-T7�'��^:ter't1C�G—'rte 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: :emvanv name: Lddress: :. fty! • ,.. ,. „r. ahone# nsurnace co. ... pail ... ..:...:.:.....:M. ....... ..:.. ...:... emoany name. ,.. . •r vr..... • ..::.:Hr,w:.}y.:n..,.wvirnyYA>;.:n:..nv.Y.•.Y•Y•:•L•rii:i;:•::•::.::.:.rw•:.r;tw..,. •:.,,;:•kw ;vhv•n .ri<J>:+vi J•'i{:::• ,w..I .. .64 2hone of: �:!+.:;�:.......... . i �.:.::�•::'r.: ... .r a� env i� �►r�• - - - --- - - ----- adure to secure coverage as required under Section ZSA of MGL 152 nes lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or ne years'Imprisonment as well as civil penaidei la-the form of a STOP WORK ORDER and a Qne of 5100.00 a day against me. I understand that a opy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby certify under tl and pen + o erjury that the information provided above is true and correct. iS .—. ate '�l/ 102) 'tint name xJJ yi . . . phone# 03 q e Official use only -do not write in this area to be completed by city or town city or town: per nit/llcense p nBuilding Department �UeensingBoarJ ' "' 0 check if Immediate response is requited _ C35eieetmen's Office �Ilealth Department contact person: phone K; nOther _ (rwwd IM PIA) 5/4/2000 Page 8 CONSTRUCTION CONTRACT This contract is by and between: Paul & Amy Ferguson hereafter referred to as "OWNER", and Blackdog Builders, Inc. hereafter referred to as "CONTRACTOR" for work at , same, dated May 4, 2000. This contract consists of this document, any plans, the Specifications and Business Terms that are enclosed. 1. CONTRACTOR'S DUTIES -- GENERAL a. To direct and control the work contracted for in accordance with the terms of this contract and all applicable codes, laws, and regulations, and as the building permits issued for this project, if any, require. b. To inspect the site, examine the plans and specifications, if any, and supervise all of CONTRACTOR's employees, and to direct the work of all subcontractors selected by CONTRACTOR. c. To maintain the work site in a safe and clean condition, to the extent consistent with the contract. d. To advise the OWNER promptly if concealed conditions are ascertained v which require additional or different work, and to proceed in such event in accordance with this agreement. 2. OWNER'S DUTIES -- GENERAL a. To provide adequate utilities for the work agreed upon. b. To advise the CONTRACTOR of any condition of the property which affects CONTRACTOR's ability to perform. c. To provide secure storage areas for materials delivered to the work site. d. OWNER shall be entitled to make periodic inspections of the work site, provided such inspections do not interfere with the work and can, in the judgment of the CONTRACTOR, be made safely. Any other entry onto the construction site shall be at OWNER's risk. e. OWNER shall notify his insurance agent of the execution of this agreement and obtain any necessary riders to his current coverage or any locally customary forms of coverage, such as builders risk, to cover OWNER's interests and liabilities during the construction process. 1 5/4/2000 Page 13 15. ENTIRE AGREEMENT This contract consists of the documents defined above, and constitutes the entire agreement of the parties. It can be modified only by a written document. OWNER acknowledges that he has read and received a legible copy of this agreement signed by CONTRACTOR, before any work was done, and that he has read and received a legible copy of every other document that OWNER has signed during the contract negotiation. SUBMITTED: ---� DATE Carl . Trull ` Designer Blackdog Builders, Inc. ACCEPTED: i ��. DATE: Paul & Amy Ferguson ALL INTERESTED PARTIES; v DATE.: DATE: MAKE SURE ALL INTERESTED PARTIES TO THIS CONTRACT HAVE RECEIVED THEIR COPY OF THE RIGHT OF RECISSION DOCUMENT NORTIy Town of 4Andover 0 CPS/A T T A o '� dower, Mass. So-IQ COC HIC HEWICK ' ' AD' ATED PPa�.(5 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... PAv)... .,,/d. „ ,,....., � : ti � Foundation V... ................. ............................................ has permission to erect.......rl.!��..�l.�........ buildings on ....�..... ....................................,.,.. ......................... Rough tobe occupied as.......... �M.M A0r.................................. . ....................................................................... Chimney Y........... provided that the person accepting this permit shall in every respect conform to the terms of the application an 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 04 VIOLATION of the Zoning or Building Regulations Voids this Permit. �30 ® Rough V Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N S TS Rough ..... .... ............ ... ......... ............ .. .. . ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. E I /,-, - Date.�' 2 3OU ........... ............. TOWN OF NORTH ANDOVER .6 PERMIT FOR WIRING . ......... '......:This certifies that ...... ..... ................ nas permission to perform .......... ....................... ............................................ wrqng in the building ............................................. at.. ... /...... 6( .. ...............................North Andover,Mass. 72rry "I � e /111 Fee :�............. Lic. /1..�.1......t ............. ....... .. ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer THECOA MONWEALTHO AM"aIU,Sms Office Use only DEf39RT11�VTOFPl1I3I.IC.S'9FEIY Permit No. tl BOARDOFFMPREYIU�WONREGUM770AS527(M]2.10 Occupancy&Fees Checked APPLICA TTONFOR PEST TO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. 0—Z &1 PARCEL O e 3'' Location(Street&Number) �j � �I "7"'•`f Owner or Tenant FFA4 G U SCS Owner's Address Is this permit in conjunction with a building permit: Yes[No (Check Appropriate Box) Purpose of Building RF Lc-7,C Utility Authorization No. Existing Service Amps / Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting OutletsNo.of Hot Tubs No.of Transformers Total ,w 4y KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.os Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch QkWets No.of Gas Bumcrs No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.ofgVryets Heating Devices KW Local Municipal Other Cormcctions No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER- lbawaanxIL2bdtyhm=PohLyurlA*CMFI&'CpwabcrECOMBWcr tsWAmtalapvdiuI YES r NO lbawsthr&dv Wrrccfof-,mmtotheOffio�-- YES I 7 1 Na Ifya.IhawduiodYES,plmmk*tbot Fcfw)wWbydiedmgthe INRR*R M M BOND MIER F-1 ftase Spaff1') EVirAmDae Est matadValu dElecical Wade$ WotktDSlatt .5 3a-�a��7 hVec6mDateRe4Ested Ra# Final s*,cdtmaxTrPwaifies ofpetjtay: F ZMNAN E �.^. i t T E�l✓!E/0 k 9—A_ FC. P&--a �%,P 1 !�L C 0 J--7-r. J�d� Li=w1 II�3 LimmePV V 31K /1l1 00 k7-k' S43attre (�; Lioa�seNo ' I �`�'30 Btaa�sTel Na � �7— gF—P Ay le—Fil M 19- 0 r %� AItTeINb OW HZRSINSURAI,UWAAUII Iamaw&etbattbeLioemdoesmthavetheaudn cmeagper tsa sf Etdegmrdkiasleq edlyN Ctn-ndLaws andthatmysi�cnthispe�rltappl�o V4M%zsttnsregmanart (Please check one) Owner Agent Telephone No. PERMIT FEE Signature of Uwner or Agent PERMIT NO. v APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. � PAGE 1 MAP KJO. X00 LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE — ZONE I SUB DIV. LOT NO. LOCATIONURPOSE OFyrW0111"SIla C re �p C_lam r .OWNER'S NAME �� �/ ) r.�/D�j NO. OF STORIES SIZE 1 / �df OWNER'S ADDRESS ( / �J/ CO J/� ✓�[/ Cl/7 C. BASEMENT OR SLAB - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME Bl� I /1 SPAN -- DISTANCE TO NEAREST BUILDING ! DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY 1UlLDING ALTERATION e IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER OAR- OF APPEALS ACTION. IF TANY IS BUILDING CONNECTED TO TOWN SEWER J�/V IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 y EST. BLDG. COST PER SQ.Aft. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PANS MUST BE FILED AND APPROV D BY BUILDING INSPECTOR DATE FIL ;24 NUILDING INOPKCTOR SIGNATURE OF WNER O AUTHO 'ZED AGENT F E E OWNER TEL.N PERMIT GRANTED CONTR.TEL.# Y� 9-L2 -000 19 — CONTR.LIC.# SEP 3 0 1996 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY SiOR1E5 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- • APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d I 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY WALL _ UNFIN. 3 BASEMENT i AREA FULL FIN. B'M'TAREA _ y, 1/1 l/ FIN. ATTIC AREA _ NO B M FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDSB 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVJ'D ASBESTOS SIDING COMtACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T2nd _ ELECTRIC 1st 13rd NO HEATING j[ i U TOWN of NORTH ANDOVER . 'AFFIDAVIT Eb Tit Caritmctr Isar I aTplg30:1, to Felmit A plicatiaa �Q,c.. 142 A Wires that the.' . r, WiM=03tM4C�=�M=a of � a�� to a6r�IxxM b.uld- NI cc arstartic� . �5'�" ==3i g at ]est ore bit imt atzo✓ .cc to steres 4ich are adjac a t m suzh reside.or halcEiie'3e da-P-lY a d , ruin ocepd s, aItzg dim Type, ype of Work: L'e�noal a is -:r Fst. Cost Address "of Work Owns Name: /VU ? �V7%r a�a7 }" Date of Permit Application:-. jo3� I hereby, certify,.`that:° t Registration is not ,required for .the- following reason(s)_ cc�r office L;se Only Work excluded by law. FaMi.t No. Date - job under $1,000. Fh,i l e�-awner-occrpe�i _Z_�er pull-ling own.. ,v Notice is hereby:. given that: C�fZgtSPULLING ZI1EIlt 4G'N PST OR DEALING WITH UNREGISTERED OONI MCMRS_ FOR APPLICAHIE HUE Il4ROVRIM WORK D0 NOT HAVE ACCESS TO II E ARBITRA TIO0 PROGRAM"OR GUARANTY FUND;III`R'ER .M c.. 142A- Sirjed use= PeMlHes of perjury: - Thereby apply for a'_permit as the. agent of the owner: Date Contractor Name Registration No.. OR: Notwithstanding the above notice, i hereby. apply for',a permit as the owner of the above property .lo% � Date' Owner Name -' «� ✓dee�anvrua�uoeall�a a�✓Cliraac�uce(�a ,:C 3�•-\ ( HONE IMPROVEMENT CONTRACTOR.'4;. Registration 119475 ' . Type.-. INDIVIDUAL ; Expiration. 07/17/97 PAUL VASAPOLtI id 132 MONTVALE RD ADMNISTg?TOR WOBURN MA 01801' . i ,. ._ ._ -. _. _,.. .. .:'. . .._.. .,_moi- -• - - . ' (C � ✓�+4-V�bnN)tfl'141/eaulc 6�✓`LCfJtMC�tLIbe�{1 ;� , �\ ( HOME IMPROVEMENT CONTRACTOR-1 Registration 119475 Type -. INDIVIDUAL. Expiration: 07/11/91 PAUL V'ASAPOLLI I GGI 132 NONTVAI'E RD , 'ADMINI$TRATOR_ ROBURN: MA'01801 - 711 v tt_•.'; ' �-c_sem'•,_ -.. ''•. s.-..-:.-" -___'- - - �- .',yap •.•.as s:..-_.. . .. - OFFICES OF: :. -__�TOWIl•Of ,120 MainStreet �f z._ APPEAI-S �s�i—�.y. - NORTH ANDOVER -_-North Mdover. BUILDING tom'�;� Massdch-L setts O t Sss CONSERVATION DMISION OF HE.-\LTH PLANNING & COMMUNITY DEVELOPMENT KAREN H.P.NELSON. DIRECTOR S In acc-crdance with the r: -s:c_s cf •IGi. S a condition of Building Pertait Numbe- •� 'is res::iting irern this work shall be disnose�.` of is a nrcne: Scud ;rite ��-^sc. :ac i rs .;..cd by MGL c in, S —Che debris will be disposed cf in: Stcnat::r,. of P .snit A60,i5dt Date :10TTZ: Demolition permit from the Tocra of :forth Andover must be obtained for ~ this project through the 0:"lice of the Building Inspector. ' - r M G 1/f , Kkhe, O raftDate CABINETRY File # 1 FT 2 FT. 3 FT. 4 FT 5 FT. 6 FT. 7 FT. 8 FT. 9 FT. 10 FT 11 FT 12 FT 13 FT. 14 FT 15 FT 16 FT 17 FT 18 FT. 19 FT. 20 FT 1 FT. CIP . t I 2 FT. N � � � -Q- , i w.3o3a. wI 3 FT. � i tiJ 6 �� I z� 8 30 cS;L. d�Ov 4 FT T- l 5 F 6 FT. z I , 1 d_� A T- 7 FT. Caw ln-n n o0 8 FTr L6 �o1?I�oo'� 1 U' c� C� p 9 FT. 10 FT. v� 303ol -o C7 11 FT I £ TOE d _ � I 12 FT ^� 91 I a-z�Ts I `3 SFT. + < �rn ��`' 4 FT. 5 FT. a x•5771' ��q�o � 6 FT. = , I Cn 7F — W i o 7-71/rn Z� 8 FT Q�Illa U7 9 FT Q Jl/ GIJa� 0 FT �s 1 FT. 2 FT 3 FT ` � n � �• _ r;1 cam. '��� 3 FT. 5 FT Ti `c"a T` FT c_ OL PROJECT Counter top Information • Fridge W Range W K.C.T.colour CUSTOMER Kitchen sink type Microwave W x H P.O./PLAN N Oven W VV x H Single ❑ Double ❑ Cooktop Kitchen Style Range hood Yes ❑ No ❑ Colour V.C.T.•1 colour Under counter D.W. Yes ❑ No ❑ _ --�- Vanity T.P. holder Yes ❑ No ❑Style V.C.T.-2 Colour Installed •❑ Supply only ❑ Colour V.C.T.•icolour Hardware.type Other Style Other C.T.colour Panelling Req'd Yes ❑ Mel 0 Oak 13 Kitchem. ; A Date CABINETRY File # 1 FT 2 FT 3 FT. 4 FT. 5 FT. 6 FT 7 FT. 8 FT. 9 FT. 10 FT. 11 FT. 12 FT 13 FT 14 FT 15 FT 16 FT 17 FT. 18 FT. 19 FT 20 FT 1 FT. . N I ' 2 FT I I W.3o,3a. WI 3 FT. i w 6111z� �SDSZ 0000 4 FT. j- p G--z CIO 5 FT. — r Z 6 FT. 77, 7 FT. I C�W lr'n n ao 8 FT 7'j W . / rQ� 9,.-1:19 o1017f oo �t� Ip CA 9 FT. 10 FT. O V� 3 03ol vV 6050 o C7 11 FT. BU 1�� I �' E TOE 12 FT 9- I a-z ala 1"3 FT. ] G � to I 4 FT. cv) 5 FT. 6 FT. . I lh rTT 7 FT. —— — — — CD '71? Z/ 8 FT. 9 �1na 07L—j _ t 9 FT. 0 FT Ca 1 FT. 2 FT : - 1 : 3 FT ' 1 J G o I FT. r: ( O 5 FT i FT. (T1 PROJECT Counter top information Fridge W Range W K.C.T.colour CUSTOMER Microwave W x H Kitchen sink type Oven W t P.O./PLAN N � x H Single ❑ Double ❑ Cooktop Kitchen Style Range hood Yes ❑ No O Colour V.C.T.• t colour Under counter D.W. Yes ❑ No ❑ . T.P.holder Yes ❑ No ❑ Vanity Style V.C.T.•2 colour Installed -❑ Supply only ❑ Colour V.C.T.•3,colour Hardware.typs Other Style Other C.T.colour Panelling Req'd Yes 0 Mel 0 Oak 0 Ottica Use Only T_ . uhP LIITYITIIIITt1UP � I of 9k5BzEr4 .SEt 5 Permit No. ,f (" i0quirtmimt 11f ilublic �fP Occupancy Fee Checked (3/ 3/90 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 C`dA 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (-,, ,I)Q or Tawn of NORTH ""DOVER To the Inspector of Wires: The udersigned applies for a permit to perform th electrical work described below. Location (Street & Number) L Owner or Tenant Owner's Address Is this permit in con�juunction with a building permit: Yes No (Check Appropriate Scx) Purpose of 8uildind- 1Ln,I df)tie— Utility Authorization No. Existing Service Amps _� \1cit3 Overhead _ Unagrnd No. of Meters Ne,.v Service Amos / Vcits Overhead _ Uncgrna No. of Ibleters Numcer of Feeders and Amcacity L ccaticn ane Nature of Proposed �!ec:ncai :'lerK iotai No. at Lignnng Outlecs /_ i No. o. =s No. of transformers KVA lY Above- In- No. of Lichnng Fixtures (� i Swimming P:cc grna. _ cmc. ! Generators KVA No. of Emergency Lighting Na. ct =ecegtacie Outlets Z No. of Cil Burners 3acery Units No. of Switch Outlets No. or Gas =urr,ers I FIRE ALARMS No. of Zones Totai No. of ^etection ane No. of Ranges / C�a�C I No. Cf Air Conc. 'Cris initiating Dav des Heat Total Tatai No. of Oiscosalsy Pur--s Tans KLv No. of Sounding Devices ! No. of Sea Contained No. or Oisnwasners - I ScaceiArea F.eazmc KLV OetectcomSouneing Devices Munic;cai --Other No. of rrers Heazzric Oev:ces KLv I Lccat _ Connecaen f No. Ct No. of Law voltage No. of '.Vater Heaters K1! Sicns 3ailasts Nirmc No. :Hyaro Massage Tubs I No. of !actors otai HP OTHE INSURANCE CCVERAGE. Pursuant zo me recuirements of massacnusers generac Laws Y — NO — I have a current Liaoiiity Insurance Palicy inciucing Ccr,_:etea Oeeratians Coverage or ;ts sucstantial ecuivaient. ES _ — I have suomittea valid proof of same 'a the Office. YES — NO — If you nave cnecxee YES. ptease indicate :he type at coverage cy cheCKtng the n aopr ate pox. /�/V ODa 21& J t INSURANCE :SONO = OTHER = (Please Scec:ty) (JCN IExairation Oacei Estimated Value of Electrical 'Mork 5 )YOP � �L Wcrx :° Start Inscec::on Daze nacuesteC: Rougn F nal Signed uncer :h Penalves`at peury. 2Q FIRM NAME `^ � `�"'� LIC. NO. n Signature 11 LIC. NO. Licensee f�3 n Ivy D q Sus. :al. No. tJ (—O / � y Att. Tet. `la. Address I— OWNE R'S INSURAN LYAIVEP: l am aware !hat ;tie L:cen5e9 odes not nave tris nsuranca coverage or its substantial eauivatenAt as re - OWNER'S ov Massacnusects General Laws. aria :nat my signature on :his cermit application waives chis reauirement. Owner r'9V 'Please cnecK one) (S 'eiecnone No. PERMIT FEE 5 I (Signature at Cwner or Ageno .,r,;.uc.i.,,�„_^i`y.�j:,�,�."'^�...�•-:.�;y:.-,::.C"`";1�+['' 'tiy-� i Date`I� 493 f NORT#1 " TOWN OF NORTH ANDOVER OL ' PERMIT FOR WIRING ,SSACHU t This certifies that .. . .. . . ... .. .............. has permission to perform . a... ............................................ 1-7 wiring in the building of...` +. n .4 ....... at.W .... ( .. .................... .......... .. .North>Andoer, s. Fee..................... Ltc.No... ........... ..... LECTRICALINSPECTOR C � ` 10/07/%, 13:314 WHITE:Applicant CANARY: Building Dept. 5`P&TFMrer