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Miscellaneous - 70 BROOKVIEW DRIVE 4/30/2018
70 BROOKVIEW DRIVE ` ` !! 2101,05�00.0 \\ i` I Date.:5)�.A! ................ ,y f� OF NORTM,� TOWN OF NORTH ANDOVER * PERMIT FOR WIRING B,�cMus� This certifies that tb.�.�? has permission to perform....� JJ 1 tiM ....... v. ................................ ..................................... wiring in the building of.... ..4..��-!vQR . ''"' ............................................................ at ............I.. ��.e. .....,.,�.. �Le- orth Andover Mass. Fee..�...�-........Lic.No.�� � t ! : a. ........ ............ . ................ �................... .. : . /?Zcje,0 ELECTRICAL INSPECTOR ' Check# ���� 12338 e�p $-- (.0 w- 4h l 20'14-OS-06 IS:48:46(GMT) 1781S33I 18'1 From:Je cuff Commoirrvealt( of 911assackusetts Official UseQO/nly Permit No. lDepa•-itment of Eire Sehvices Occupancy and Pee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/091 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with die Massachusetts Electrical Code(MLC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORRIATION) Date: 5-6-2014 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 el e trical work described below. Location(Street& Number) 70 Brookview Drive VW) Owner or Tenant Brenda Faulkner Telephone No. Owner's Address Same Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Bos) Purpose of Building Residence 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: 2nd floor bathroom Corn lesion of the following table may be waived by the Inspector of 111ires. No.of Recessed Luminaires 2 No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers ICVA No.of Luminaire Outlets 2 No.of Hot Tubs Generators KVA No.-,of Luminaires Swimming Pool Above El 'n- ❑ o.o +mergency ig hang rod. rod. Batter Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS No.of Zones No.bf Switches 3 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No. of Alerting Devices Tons c _ No,of Waste Disposers Heat Pump .Num Tons KW No. of Self-Contained Totals: __.- - Detection/Alerting Devices No.of Dishwashers Space/Area Heating ICW Local❑ Municipal El Other Connection � No.of Dryers heating Appliances ICW Security Systems:* No.of Devices or Equivalent No.of Water ICW 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 11,1ires. Estimated Value of Electrical Work: $1,500.00 (When required by municipal policy.) Work iso Start: 5-6-2014 Inspections to be requested in uccurdance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical wort:may issue unless the licensee pro----- ' vides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specily:) I certify,tinder the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Facilico,Inc LIC.NO.: Al 7545 Licensee: Paul Santangelo Signature �� ,/Z� LIC.NO.:E30998 (Ifapplicable,enter "exempt"in the license number line.) Bus.Tel.No.: 866-929-2100 Address: 10 Walnut Hill Park Lower Level Woburn,MA 01801 Alt.Tel.No.: 617-201-4373 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie. No.: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.$ - _ Q ��-� ° � � � z7-r ��P�y - -- - To: Page 5 of 6 2014-OS-06 15:48:48 (GMT) 1 781 9331 1 8'1 From:jean cuff TM COMMONWEALTH OF MASSACHUSE.n'S. .:' .. .. ' :•:.BOARD'OF ELECTRICIANS ; 1 I SSUES .THE FOLLOWING- LICENSE .-—, ::�, AS:'.A:..RE.Q- JOURNEYMAN -ELECTRICIAN iuu PAUL .S' SANTANGELC+ �z In 33 VI NC ENT'-'RD ,w " IU W: ROXBURY- 'MA 02132-7824 IJ 1 0 $ .E: 3:..... _ 0 o p r I ` i 1 To: Page 4 of 6 20'14-OS-06'15:48:46 (GMT) '178'1933'1181 From:jean cuM The Commonwealth ofMassachi/setts Depart//I mit of Inditstria[Accidents _ = Office of Investigations 600 Masliington Street -'- Boston,Nlass. 02111 ---=-_ -:----_: ►ututt�.�nass.Potj/clia Workers' Compensation Insurance Affidavit: Builders/Contractors/1!Jlectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Facilleo, Inc. Address: 10 Walnut Hill Park Lower Level City/State/Zip: Woburn, MA 01801-6823 Phone M 866-929-2100 Are you an employer? Citeck the appropriate box: 1. ® I am an employer with 12 4.0 1 am a general contractor and Type of Project(required): employees(full and/or part-time).* I have hired the sub-contractors 6. ❑New Construction 2 I am a sole proprietor ur listed on the attached sheet. •❑ P P • 7. El Remodeling partnership and have no employees These sub-contractors have working for me in any capacity, employees and have workers' 8. ❑ Demolition [No workers' comp. insurance comp. insurance.$ 9. ❑ Building Addition required.] 5.❑ We are a corporation and its 10.® Electrical Repairs or Additions 3.❑ 1 am a homeowner doing all the officers have exercised their 11.❑ Plumbing Repairs or Additions work myself. [No workers' comp. right of exemption per MGL C. insurance required.]) 152,A 1 (4),and we have no 12.❑Roof Repairs employees. [No workers' comp. 13.❑Other insurance required.] Any applicant flint checks box ill must also rill out the section below showing their workers'compensation policy information. 4'Homeowners who submit this ufTidavit indicating they are doing work and then hire outside contractors must submit a new affidavit indicating such. Contmctors tint check this box must attach an additional sheet showing the name orthe sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I tint tut employer ilial is proi,irling workers'coiiipensatioii insurance for my e»nployees. Belo iv is the policy enol job site inforniatio«. insurance Company Name: St.Paul Travelers Policy#or Self-ins.Lic.#: IHUB 87K 735 5312 Expiration Date: 516/15 Job Site Address: 70 Brooltview Drive City/State/Zip: North Andover,MA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up,to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certij}�«nde�fe pain s a«r «a li. f perm rill r�e in formation provider!above is true and correct. S i nature: !. Date:5-6-2014 Phone#: 866-929-2100 ' OJJicial use only. Do not write M this area, to be completer!by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: 11 104- 76 Date..... ....... o'er t4ORT#1 03� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �/ ��. Thiscertifies that............................................ **... .. ....................... 7A ................... rrmi sion to perform...... 77'�! pu M,&C s ........................................................................... has pe ..... ...... plumbing in the buildings of e...4 ......................................... at..... ........lJk4.?� ............ North Andover, Mass. Fee.5;?.' Lic. No.A.............. .. ........... ................................................. PLUMBING INSPECTOR Check# A, tq V-A_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY V MA DATE _ ( PERMIT# U JOBSITE ADDRESS vie4, 2f4:VOWNER'S NAME POWNER ADDRESS TEL �1a FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL4 PRINT CLEARLY NEW: M RENOVATION:, REPLACEMENT:DI PLANS SUBMITTED: YESE11 NOR— FIXTURES 7 FLOOR--> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 4 —_ { I. ( -_-__� CROSS CONNECTION DEVICE ! _.. -_I DEDICATED SPECIAL WASTE SYSTEM _ _J DEDICATED GAS/01LISAND SYSTEM I --_- ._ DEDICATED GREASE SYSTEM =j DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREADRAIN _9 ..__.___1 _____► ____( -__- I __..._ __.___J -__...._f ____J -_- ____-. _.._� ___I _____( INTERCEPTOR(INTERIOR KITCHEN SINK LAVATORY ROOF,,DRAIN ( I f { f I SHOWER STALL .__.J _-J -___I ----J SERVICE/MOP SINK TOILff 'i URINAL f WASHING MACHINE CONNECTION i _ ! _....._.... J _-.._...JJ _ __1 J J -( ..-.. — _1. WA ER HEATER ALL TYPES _I I __-J f 1 U�ATER PIPING _ f I ___... OTHER __ I J J7 t 111 I _ 11 _._ 1 -__.-J INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES RINO �1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 iTO Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER F AGENT (� SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent pro ' ion Vine Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# SIGNATURE MP© JP CORPORATION[�J#PARTNERSHIP�# ;LLC COMPANY NAMEADDRESS CITY.I/(/, Pllr� .. ---.-_._.._]STATEZIP TEL FAX _ CELL EMAIL /vlm S f 9 \F XiA 11 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE US ONLY FINAL INSPECTWN NOTES Yes No Aaa THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTEFS i t ' The Commonwealth of Massachusetts - - Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Le0bly Name(Business/OrganizatiorAndividual): 131v4 3 1001 Address: City/State/Zip: /V,✓�a er1 ,,fit 0 �- Phone#: ?P —a Y Y-a Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.�am a sole proprietor or partner- listed on the attached sheet. �• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9• E]Building addition [No workers'comp.insurance S. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11 dumbing repairs or additions myse o wor ers comp. Ito-of repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ��-- Insurance Company Name: ��✓�1V�2/' !�/!�U/ l Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 7 6 e e,. d/U✓P City/State/Zip: P, �, — Attach a copy of the workers compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certifyun r thepains andpenalties o perjury that the information provided ave i$true and correct. Si afar Date: � Phone#• u/ D Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: c. ti . Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An 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' J rp including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association on or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the um-ber3or partners,are not require to carry compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigatitons 6.00 Washington.Street Boston.,MA.02111 Tel,#617-727-4900 ext 406 or 1-877,7MASSAFB Revised 5-26-05 Fax#617-727-7749 vw mass.govfdia COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICFNSED AS A JOURNEYMAN PLUMB R ISSUES THE ABOVE LICENSE TO: c LAWRENCE J CREHAN '. 6 MEADOW6G;EN ;.RD 1 V ` c r i N BILLERIC ARf` MA G18G2.�2?D4 25.995 95/01!14 A83602 Date.. /ZS�z-.. . ... .. . Of ND oT~ 1,�, o= �` TOWN OF NORTH ANDOVER r- F • PERMIT FOR GAS INSTALLATION �,SSwCMUSEt This certifies that . rr r has permission for gas installation . 161�2kgen. . . . . . . . . '• in the buildings of . . . "I— . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .7U. . . . . . . . . . . . . , North And ver,, Mass. Fee 4:r-ov . Lic. No.< 5�? . . . .� . . . . GAS INSPECTOR Check# //7.3 8024 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK uwrCITY ,`�1U �"/✓ v �- MA DATE j Z PERMIT# JOBSITE ADDRESS .7 t��uv VI .1 Vt./ � OWNER'S NAME zr��_ //J��✓ t � GOWNER ADDRESS s_�J �y eTEL[ FAX L� � L__ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL [-] RESIDENTIAL PRINT CLEARLY NEW:GI RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO[� APPLIANCES-1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 1 13 114 BOILER I BOOSTER -; - CONVERSION BURNER COOK STOVE DIRECT VENT HEATER _ - - -- -- DRYER FIREPLACE FRYOLATOR FURNACE _ _I GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT - L It - OVEN - POOL HEATER - - I ROOM/SPACE HEATER ROOF TOP UNIT -- � I TEST UNIT HEATER - - _ - - - UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES FKj NO [ __ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY nA, OTHER TYPE INDEMNITY [_] BOND F] OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER III AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru nd accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com iceAth all Pertinen rovisio f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R'�� �:� '� fI LICENSE#-ilk k SIGNATURE MP k_j MGF�__) JP[y. JGF LPGI CORPORATION PARTNERSHIP #�� - d- LLC[ ]# COMPANY NAME: ��� ,�, // CITY STATE Nl ZIP[o y_�7TEL (� U FAX ��� CELLf f4MAII ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Date..��a�?.7... . ...... . . NORTh O?Oya..ao ,e 1M0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,SSACMUSEt This certifies that . / r�_ has permission for gas installation . .s' eh�c l�. '���.dwu./rh�9,e in the buildings of . /.r'.'e .ZH41.149 . . . . . . . . . . . . . . . . . . . . . . . . . at . . .',7a. Amf h (/iev . . . . . . . . . ., North,.Andover- Mass. ,W Fee.4W Lic. No.1���-� GAS INSPEiT Check# OL 7 7990 �w s MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: eft�OJ�6� , MA. Date: / 3 Permit# w Building Location: /Q ��� _ Owners Name:11/✓' 1,�/�IBD�$� Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional ❑ Residential [Y� New:❑ Alteration: ❑ Renovation: [r Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES IX a.� W H Y x H m M O W W O N F O x WW �°—� W W W z m o F =a iW- o w x uj LL W I- ¢ W W w z e� m W O� z w z W yW N J ~ O W O Z O ~ h W z W o ac a m > o o W z z W a P > H 'S O SUB BSMT. BASEMENT 13T FLOOR / r 2 NLFLOOR 3 FLOOR 4 FLOOR KrRFLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name:/"!/."�!//�1,�!st/�, �pfal/G�O; • Corporation Address• A �1c /D C' /Town:,^t ,moi✓ State: " ❑Partnership Business Tel: 6,��1n�5"�83�3 Fax: �l�S-S3S� ❑Firm/Company Name of Licensed Plumber/Gas Fitter: p INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes R No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Cod!7d Chapter 142 of the General Laws. jyjp4 of License: By Plumber as s Fitter Signature o icensed Plumber/Gas Fitter Title ❑16a Master t7 cityirown ❑Journeyman License Number: o APPROVED OFFICE USE ON L El LP Installer R t f i ��j�v�� � x'1/`2 t/�( �-- �''@--� ,��Q�� . � .� �,� ti The Contmoinvealth of Massachitsetts -- Department of Industrial Accidents Office of Investigations 600 Mashington Street Boston,MA 02111 -•_� impmmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibiv ,� r Name (Business/Organization/Individual): / �!/,Q��� ��j//� ifr�j et/�r'+ J•��,t/� Address: J�e- City/State/Zip: /� Phone Are rree/you an employer?Check the appropriate box: Type of project(required): 1.1� 1 am a employer with /IP _ 4• ❑ 1 am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g ❑Demolition_ working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance# 9. Building addition required.] 5. 0 We are a corporation and its 10.El lectrical repairs or additions 3.ElI am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑ Other employees.[No workers' comp. insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that.check this box must attached an additional sheet showing die name of the sub-contractors and state whether or not those entities have _ employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am air employer that is providing workers'compensation iastirancc for rrry employees. Below is thepolicy and job site information. Insurance Company Name: �/�� �d�,� • Policy#or Self-ins.Lic.#: �j' �,30�lo Expiration Date: /0 do Job Site Address: /,g �1�/ City/State/Zip:/�'� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this-statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify uud he pains and penalties of erjn that the infornnation provided above is trite and correct. Signature: / l p Off_ Date: 3 Phone#: Official use only. Do not write in this area,to be compiled by ciq►or town official City or Town: Permit/Llcense# 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#: f- .�.rwn na,nw.:._r..c--,gin.•;•q t. '*!7•f' atfi 'i�.-.- -_ ,_- I r L AM`NIISOTTERS REGISTERED AS A'.PLUMBING CORP.- GEORGE R LAROSE ...--,-'.--ANDOVER PLUMBING & HEATING C , -- 20 AEGEAN 139*- _ _-UNIT _:UNIT 10 METHUENMA 018.44-1580.` 2122 05%01./.12 _784263;... .� _ L' .. •TN:'!= ... G:;`.:. ., �...-�- _.. —,:,:.fir...._r�r.:-,. oo,:,i..;��....h-• .r _. s llil PL "LICENSED AS A JOURNEYM IW ''-:_° ANW-6A RS LICENS DASA MASTER.PLUMBER GEORGE -R LAROSE6EORGE R LAROSE 44'MILE .ST = ; =,44=" -ODILE STREET - ; _:METHUEN MA:-:03.844-4233•, : METHUEN MA 01844-4233 18725 _ 05/01/12 784282 9983 Q5/01112 78428 • 1 Date. 2.. ... .. r NORTH TOWN OF NORTH AZILLATION'OVER Y. o PERMIT FOR GAS INS 9 ,SSA USE�I( This certifies that a�. . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . .".cf. .7. . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at 13.At.c-/'.t,�c.c...... . . . . . . . . . .. North Andover, Mass. Fee.?.L . . . Lic. No.3 0.. / . . . . . . . ,'ASINSPECTOR Check# 3 S�, r 5962 r t MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date �� � Permft # 5 C L Build i Lo cation 1 �i�J7 wner's Name e V Type Of Occupancy New ❑ Renovation ❑ Replacement p� Plans Submitted: Yes❑ No D/ N C y. W YI U1 Ch N N U W W N• S O V ID. r .Z fIi H .C,19 t N, � N O Z O ~ W O Vi W 2 < W ¢ W O 4 < i O O W c D tf H > D a F* O SUB—HSbtT, f BASEMENT ISTFLOOR . 2ND FLOOR f 3RD FLOOR ( i 4TK FLOOR STK FLOOR 6TKFLOOR 7TK FLOOR . STH FLOOR _di I 1 —1 F7 i I I -I installing Company Name Kb`YSPA�1/ KUl�1'1� G7 ]zC S k i/C�`� Check one: Certificate I�Corporation �/� � '�2)t/,ZL_W6-PT A1, olc9o3 7, Partnership Business 7elephone,26V`359-AL_z D Firm/Co. Name of Licensed Plumber or Gas Fitter Awl k-9V INSURANCE >�Vdky ER GE: I have a currefnsurancr policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No O If you have checked jes, please indicate the type coverage by checking the appropriate box. A liability insurance policy `D. Other type of indemnity O Bond D 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 an this permit application waives this requirement. Check one: OwnerD Agent-[D &gnature of Owner or Owner's 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 thepermit i d for this zpplication will be in compliance with all pertinent provisions of the Massachusetts State,Gas Code and Chapter 142 of the neva Laws. By 1�e.of License: 9 J Plumber _ atuie of used P , r or G E rtter Titie Gasfiner J Master license Number Gty/l own Joumevman APPFOVEID (OFFICE USE.5NL ) R BELOW FOR OI•FICE IME ONLY PROGRESS IHSPEC71oN FINAL IHSPECTIOII SKETCHES FEE N0. APPLICATION FOR PERMIT TO b0 OASFITtINO IIAME.A TYPE OF DUILDINQ --------- LOCATI011 OF BUILDING PLUMBER OR GAS"IlER LIC.110. . PERMIT ORANt6D BATE 19 OAS INSPECTOR i N° J 13 Date../7,. ... ..... rj NORT►, AL °f' °:•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ACHUSEt q X��E-/ �. —.s.« This certifies that .. .. .'. - -n _ has permission to perform ......................... wiring in the at...., ; . North Andover,Mass. z o Fee . Z! ........... Lic.No. �L• /r>I ............. ............................................................... ELECTRICAL INSPECTOR 09/03/98 12: 97Iy WHITE:Applicant ANARY: B It1i De iD PINK:Treasurer Office Use Only Permit No_ A a 05 x45ss wlss-7775 D Occupancy 8 Fee Chested P-&&s lug BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK A)I work to be performed in accordance with the Massachusetts.Electrical Cade 527 CMR 122::00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Numbe/r�_� Owner or Tenant �Idf� Owner's Address U O rC l tier�� VA. 7 Is this permit in conjunction with as building permit / YeseC3.� No ❑ (Check Appropriate Box) -7 Purpose of Building "I.-, l( l G7 Utility Authorization No. `G 7 /77 I Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service "20y Ampsisle d L Volts Overhead ❑ Undgmd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed E!ectncal Worik �2t 7Z 0 6 y -� Total No.of Ught8nq Outlets No.of Hot fuse No.of Transformers KVA Above C In C No.of Lignting Fixtures Swimming Pool qmd ❑ gmd ❑ Generators KVA No.of Emergency Ugnang No.of Receptacles Outlets No.of Oil Bumers Sattery Units No.of Switch Outlets No of Gas Bumers FIRE ALARMS No.of Zone Total No.of Detection and No.of Ran es No of Air Cond Tons Initiating Devices Heat Total Total No.of Oioosal No. Pumos Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Soace/Area Hearing KW OetectiontSounding Devices C Municipal C Other 19 of Dryers Heating Oevices KW Local Connection No.of No.of Low Voltage fro.of Water Hearers KW Signs Batlases Winn No.Hydra Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 1 have a current liability Insurance Policy including Completed Operations Coverage or its substantial equivalen YES NO = have submitted valid proof of same to the Office YES= NO = If you hive checked YES please indicate the typ coverage by checking the appropriate box INSURANCE = Bi3f4 --=-(FHER-- {-Please-Specify) I Estimated Value of Electrical Works GZ�a CD (Expire on Date) Work to Start Inspection Date Resquested Rough Final Signed underth�^Penalties of perjury: FIRM NAME Y t l l G b.,1A-_t_ C�1V fi n LIC.NO. Z9 7v L Aicensee 5 c,✓���� Signature LIC.NO. Bus.Tel No. OF A4drasa �`� �'�"`� ��R-e l VVX Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE Sill-01 � (Signature of Owner or Agent) u�Q Y 1 O MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING 1Type or print) Date 19 NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# Amount$ -e-v✓ Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ z c w F a z Z o z w O o F. �, c�7 w Q w z �" p > w x w z u w a �' w � w F a F x U F z a F x w w C > w F V 4 `� w z w > w z d a -It a o o w x o w F a x o SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) /) Check one: Certificate Installing Company Name ®`/n/Cl'/t(.,ti fn('!�t'S r" l Corp. Addressy 1 n *' f"M Ai�N' ❑ Partner. 30 3� Business Telephone ar;- 7-7-7 77- irm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked Les,p se indicate th coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ 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 es Code and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber 25L;:2- City/Town ❑ Gas Fitter cense Number Mas APPROVED(OFFICE USE ONLY) Oumeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING r (Type or print) NORTH ANDOVE SSACH E Date y Building Locations 7Dr �� /y/oOK� Pa/ Permit # Amount 3.-A/, e�✓ /7E Owner's Name i New Renovation Replacement Plans Submitted FIXTURES z z a CA 0 a a d H '� R a oda fl4g1VkNI' t%R M 2ND FlOQt ;� 3MRfm 4M FIOM SIH FUM 6M F10CR 7M RO R g>HR m (Print or type) /� // .-] Check one: Certificate Installing Company Name A-dll(v✓ rr'NC S � �l I Corp. AddressI f/�-t YL P tel/(c/ rv, Parte z� Business Telephone o4 7 3— �S'� Firm/Co. T E Name of Licensed Plumber: Insurance Coverage: Indicate the insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance 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 p formed under Permit Issued fo;this application will be in compliance with all pertinent provisions of the Massachus t lumbi Code a hapter 142 of the General Laws. By: I re ot r-icensea Plumber Type of Plumbing License Title 3 71 " i City/Town License Number Master Journe an APPROVED(OFFICE USE ONLY E 1 Date. . . . . . . . . . . . . icy= 3675 HORTM ' �;<.�•° '.1tio TOWN OF NORTH ANDOVER t �: ._�. ..... OL i PERMIT FOR PLUMBING W1331103 ,SSACMusEt ._ f . � This certifies that :: rc -�- . . . .. . has permission to perform .`-. � . . . . plumbing t he buildings,of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fe&-�; . . . . .Lic. No .'7 .?! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer ,7 ` 2839 Date.. .`.......�f.:.�'r ,aORTN TOWN OF NORTH ANDOVER =Oya41.ao ,e 16 PERMIT FOR GAS INSTALLATION f D • ° � "a ,SSACHUSES 110 This certifies has permission for gas installation . . in the buildings of . . . .:. .`. . . ". f " . . . . l . . at . . .'. . . . ` .. .. . . . ::: . . . . . . . . . . . . . ., AhkAndover, Mass. Fee. . > Lic. No:. . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Location xY`7C VL -J.�i I / i . No. Date f 1 "pRT" TOWN OF NORTH ANDOVER pf t1`•o ,•'1•`• it A Certificate of Occupancy $ } r Building/Frame Permit Fee $ sACMUs t� Foundation Permit Fee $ -etierPermit Fee $ Sewer Connection Fee $ PAI®By Cf ftWonnection Fee $ n -� TOTAL $ 55 0. dO NORTH ANDOVER COUIECTOR 239 i i g In p cta t ; f® Div. Public Works PERMIT No. v APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE MAP {-10. �QA7LIGLOT NO. ?,t'eteT 3 Ty 2 RECORD OF OWNERSHIP (DATE OKy '.PAGE ZONE �./ I SJB DIV. LOT NO. ��' , eoerVrcl'i 10!//YT�' ��OAf$ 6 'y 7 I 7BO�� ..:.. ... . - 7 rN 5 IC17.r.J� �R lAj }�LOCATION /.S�Coo�//F, ) Q�/' ,� ,/� PURPOSE OF BUILDING f ___ •_ V OWNER'S NAME ?��e f/v/Y1(H/� 4eov �_` t/J oot/M'e( f'/"' NO. OF STORIES SIZE i /� 1� [' ff �7 _ . . _ ... ....:., s •1 OWNER'S ADDRESS v B`X ,S�I BASEMENT OR SLAB _ /s 4s( Ml 7 ARCHITECT'S NAME A�e�Nb AS C6�.r ��S 81ZE dF FLOOR TIMBERS IST 2 X I 2NO 2% id 3RD BUILDER'S NAME Af60R1 eyeeoy-yn-K I XDml.s SPAN / DISTANCE TO NEAREST R'JILDING _�-pe DIMENSIONS OF BILLS _ _ x 6 DISTANCE FROM STREET f00 / - POSTS DISTANCE FROM LOT LINES - SIDES �6 /�.11V / REAR .�7 GIRDERS L 2�,YI-I,) AREA OF LOTJ y 412 SF FRONTAGE HEIGHT OF FOUNDATION 7� /Q t'/ THICKNESS V IS BUILDIyG NEW +/es SIZE OF FOOTING IC X .3Q 18 BUILDING ADDITION Y Na MATERIAL OF CHIMNEY IV Zr�o e���C IS BUILDING ALTERATION IV IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONF:)RM TO REQUIREMENTS OF COPE ` e 18 BUILDING CONNECTED TO TOWN WATER �5 BOARD OF APPEALS ACTION. IF ANY N 6 IS BUILDING CONNECTED TO TOWN $EWER /v D 16 BUILDING CONNECTED TO NATURAL GAS LINE e5 INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SD o SEE BOTH SIDES [ST. BLDG. COST 70 PAGE 1 FILL OUT SECTIONS 1 - 3 [ST. BLDG. COST PIER SQ. FT, r ( PAGE 2 FILL OUT SECTIONS t - 12 - UT. BLDG. COST PER ROOM $[DTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 A43PROVED BY 5 ATTACHED GARAGES MUt3T CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AN APP VED BY BU DING IN PELT DATE FILED 2 / ■UILDING INBPiCT01 17 SIGNATURE OF OWNER OR AUTHORIZED A HT \ F E E -OWNER TEL/ 6 -fl 0 ? �y�� ��✓r PERMIT GRANTED CONTR.TEL I 19 CONTR.LIC.I .. H.I.C.I ..,.04AL1 16AW G R E C O R D 1 OCCUPANCY SINGLE FAMILY S.ORI S MULTI. FAMILY' ofFICFs THIS SEC IOIy,�1.A�U-S IS.N W XAGT !_I.j ,N.S ,_N ;-F LOT AND DISTANCE FROM LOT LINCS AN � " C r .. APARTMENTS o.... -T�}Di1E;�V£r10NS QF BUILDINGS. WITH PORCHES. GA- x RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION Z FOUNDATION 8 INTERIOR FINISH CONCRETE J' 7 7 13 Q CONCRETE BI K. PINE DRY V/Atl BRICK OR STONE HAgOW 0 PIERS PLASTER _ UNFIN. ` 3 EASEMENT AREA 'FUIL NdI FIN. S-M'T' AREA _ ATTIC:AREA _ NO B M'T FIRE PLACES HEAD ROOM _ MODERN KITCHEN _ 4C 1 ' 4 WALLS I 9 iLOORt 5 CIAPSOARDS S I 7 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD",'D -. ASBESTOS SIDING COMI.IGN VERT. SIDING _ ASPH. IItE _ STUCCO ON MASONRY S(UCCO ON FRAME - &RICK ON MASONRY ATTIC STRS, A OR I_ BRICK ON FRAME CONC. OR CINDER BIK. STONE ON MASONRY WIRING TON N STONE RA O FRAME SUPERIOR 11 1__iADEQUATE NONE ' 5 ROOF 10 PLUMBING ISI GABLE HIP BATH 13 FIX.1 _ GAMB9El MANSARD TOtIEf RM. II FIX.I FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY 1_ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 3 GRAVEL STAU SHOWER _ ROIL ROOFING MODERN FIXTURES TILE FLOCR TILE GADO 8 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNAI'E 4 FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL SMS,.& COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G _ UNIT HEATERS _ . ') NO. OF ROOMS GAS OIL aS` S M'T 2nd _ ELECTRIC Irr 13rd 11 NO HEATING K t k 1.10RTy Town of _ ve N o. Llr dower, Mass., 1998 LA �O'9�-COCNICMEWICK S Aq TED �G BOARD OF HEALTH PERMIT . -.-A DLO'� S" Food/Kitchen Septic System ,/ BUILDING INSPECTOR THIS CERTIFIES THAT...................................��. .. ..Q.rC...v. . .......... Q.I�.A( .. ........ if* .F►S Foundation Y hasermission to erect.....................I................. buildings on...... .. .1 ..(.�E. p g .0.....�l��.Q. .l��.....�.�..�. ........... Rough to be occupied as................................................ 6. . F................. ( Chimney provided that the person accepting this permit shall in every respect conform to the t sof the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspectio , Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STAR ELECTRICAL 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 Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. FORM U - WT R=ASR FOM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Dol�y�G� OLy /%lGrfi<s Phone LOCATION: Assessor' s Map Nu.-nber y69 t��S�fI Parcel 3 �` tsaeW Subdivision ��Q Z- S7 Trs Lot (s) Street �ed u�C'zrJ �P�u St. Nu.:i-,er ************************Official Use Only*******************x**** 11DATI02 S OF TOWN AGENTS: r1 G� Date Aurroved l l on se_ :at_cn :pis trator Date Resected rt Cc=er.-c IK Date Approved -2-\ q Town Planner Date Re j ecued Cc=er.:s Date Aurroved Fced --srect^ralt-h Date Rem ectc_ _yV_-. _. Date Appro,`,e-y ,,21R gip- Ir.spe� :ear � Date Re;ec-- Co�.._.. connectionsOiy ✓Me IS `Z �3 dr_vewav perm. it js Z3 /10 F_--e Derartmert�/C Recei•ied by Building Insrector Date im0 800 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. F�!'C' 19 Application by the undersigned is hereby made to connect with the town water main in &Vb 942 k� Street, subject to the rules and regulations of the �Divisi of Public Works. �y The premises are known as No. 'l� �, C Street or subdivision lot no.f��k (� i v,etil Owner Address Contractor Ad e plicant's Signature S7 PERMIT TO CON ECT ITATER MAI A The Board of Public Works hereby grants permission to to make a connection with the water main atBrcy) V Street subject to the rules and regulations of the Division of Public Works. oar of Public Works By Inspected by Date See back for rules and regulations ---- ------- ------------ RULES AND . REGULATIONS GOVERNING THE INSTALLATION 1 No persons shall tap or in an OF of North Andover without a valid way tam WATER per with water SERVICES permit from the Division mains which are 2. All water services shall be installed a of Public pan of the distribution Works, system of the Town 3 No minimum of five feet below the finish water services shall be backfilled without ins grade. 4• Service connections shall be 1�� inspect- 4. by a representative of the D.P.W._Telephone 687.7964. 5• All fittings type k copper tubing. g shall be brass flange type Mueller or equal H '5202 Corporations 2 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6• Curb boxes shall be installed at the Property line and shall be of the Erie Type with 4%z foot rod and brass plug `fir P!JBLIG WORK ,)64 05GOGO STREET. 01845 GEORGE P=ONA Telephone(508)685-0950 r := Fax (508)688-9573 OF °t ? V0 O � a 9SSACHuSEt DRIVEWAY PERMIT Date: LOCATION: 726 BUILDER: 4/N�_phone: �s OWNER: phone: The North Andover Superintendent of Highway Utilities&Operations MUST be notified of the grade and set-back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: Restricted To: 00 17 6'5 071 :' 1 i. 1,� (Ir y7777,Ir7,I,rIq/�1! I'✓ %/./:,,.7./,,.,P��� 00 None DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE IA - Masonry only € rs` Nuiber: Expires: Birthdate: I; 1G - 1 & 2 Faaily Moues CS 005693. 01/13/1998 01/13/1954 Failure to Possess a current edition of the Massachusetts State Buiildin Code Restricted To! 00 9 9; is cause for revocation of this license. DAVID A KINDRED 1 i 40 MARBLERIDGE RD POBOX531 N ANDOVER, MA 01845 a w w Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit(below) Address of Property for Permit(below) Qrotrit-Al AleJ?V gioves Map and Parcel : rpose of Application (check below) Phop_jj Nu er f licant: Single Family Two Family Mer gf I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit iq issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. !hThis is an application for a building permit for the enlargement,restoration,or reconstruction of a dwelling in existence as of the effective date of this by-law,provided that no additional residential unit is created.XY,"The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning w. This application is for dwelling units for low and/or moderate income families or individuals,where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents,where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section"senior"shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density, (buildable lots),below the density, (buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction,dedication to the Town,or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccur ation, or the checking off of an above item which does not comply,whether done to my know.4 dge or n t, is grou s fobrefusal by the Building Department to issue a Building Permit. / lyt-e �2 z S,0 ature o caner or Au horized Agent who signed the Attached Building Permit Dat is fornfmust be attached to the Building Permit upon application for such permit. CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 61�6 Date THIS CERTIFIES THAT THE BUILDING LOCATED ON 7eO 'er c..•.-/b� ��7 MAY BE OCCUPIED AS SS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Q. "°"'" , CERTIFICATE ISSUED TO �? ��, '..,•.•roc ADDRES t,��� 1-�.� � �'SA use wilding tnspector a r i i i I I own of _ _ - over * 0 i dover, Mass., �_ : '—'1--1998 9�COCHLA ICH WICK , ./ V 9� Oq.4 T E BOARD OF HEALTH PERMIT T DFood/Kitchen "� Septic S e THIS CERTIFIES THAT..................... / BUILDING INSPECTO .............ag.�..�.1. ... .�. .4j.........C.. ./1/ .y....... .. . .f .E.S F atio has permission to erect.....................I................. buildings on .....7.0..... ....... ou tobe occupied as................................................ ................r,#M.1... .,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 relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING.INSSPCTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. �' PERMIT EXPIRES IN 6 MONTHS ELECTRIC INSP''O ,' UNLESS CONSTRUCTION STAR R__..oug.___ / .................................................... ....... ... ....................................... BUI ING INSPECTOR js Occupancy Permit Required to Occupy Building RAS sVECIORs ou Display in a Conspicuous Place on the Premises — Do Not Remove to L t No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner �Sp(', "'�`�� Street No. Smoke Det.