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Miscellaneous - 700 CHICKERING ROAD 4/30/2018 (2)
T 0 00 W 0 0 6 a 0 0 0 mi MI /1 Date ...... 7.:....x.15........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............�� ......1�'l ,1�.../..... ............................................ has permission to perform....v.t...h......y�-e...1...1......5..................................... wiring in the building of........ .... !I... ���'1.G(......... .......................................... at�.....Noh Andover, Mass. ....Q....C.A. Fee.......'..... Lic. No.�U..>.......t�.......... ELECTRICAL INSPECTOR Check # 1'30/2016 1 2081% This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20817 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that Kimberly E Casella has permission to perform replace toilets and lav plumbing in the buildings of 700 CHICKERING RD N ANDOVER, LLC at 700 CHICKERING ROAD, North Andover, Mass. Lic. No. 15232 Date: June 30, 2016 II MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I North Andover I MA DATEJune 10, 2016 PERMIT # JOBSITE ADDRESS 1700 Chickering Rd OWNER'S NAME Ashland Farm at North Andover POWNER ADDRESS TELI 978-291-5071 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ® RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES ® NO© FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 .___.__"L BATHTUB--- r-- �_ �..____.. , _.__ �_#_ ..._. (=j CROSS CONNECTION DEVICE € _m __ _.._ DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) (€� f�- "�-� _ =j �m_;.�._. ,......�.��.�...�:;�.�._�-_.�__ � _-- KITCHEN KITCHEN SINK 1 LAVATORY �� 1� ROOF DRAIN ._ .. �,. .__ SHOWER STALL SERVICE/MOP SINK TOILETI J- L -t J - LQ LU L4:_I� �l F URINAL I ( I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING I , OTHER]___-__..._�._�___� Hand sink INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES [j NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej 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 (j 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 bei compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I'M" oyyhp PLUMBER'S NAME Kimberl Casella LICENSE # 15232 SIGNATURE MPF'1 JP® CORPORATION El 2666 PARTNERSHIP®#LLC[J#� COMPANY NAME Cranne Companies, Inc ADDRESS 110 Rainbow Terrace CITY Danvers STATE Ma ZIP 101923 TEL 978-907-0019 FAX 978-750-0535 CELL 978-882-3751 1 EMAIL I kcasella@cranneycom anies.com W H O z z 0 U W a z a d z w o� z z }El o � w W o W a ft Z O a a CC w O > IxN z J W Q � U J a a a � w = W H LL W F� O z z 0 U W 0. z c� z m a m 0 a c► . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kv 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Address: 1 U 2 o q til V A/o -7.e r r( -'A t City/State/Zip: D (yii/-ers, AAA 01603 Phone #: M0- C Areyou an employer? Check the appropriate box: 1. [ 1 am a employer with .. rD_ 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other "Any applicant that checks box HI must also fill out the section below showing their workers' compensation policy information. t Ilomeowners who submit this affidavit indicating they arc 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: 125 C t:�_M/1) VPS �k,41_60 CC Policy # or Self -ins. Lic. #: �� QQ q 0QC) t-�—] %t` Expiration Date: (�3�a S/ O o! 6A MA-/-NP� Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as 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 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 under the pains and penalties of perjury that lite information provided above is true and correct. Date: Phone 9:�(��Gi - �% 0 0 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. Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: . J P_linnf i• 1I;QAA P0ANrr1MP ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNYYY) 3/21/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Richards Robinson Sheppard Insurance LLC CONTACT NAME: jmurray@rr8ins.com �"�4NN, 617 284-5267 Arc Ne ; 617.654.9044 152 Conant Street E-MAIL ss: certificates@rrsins.com Shite 304 Beverly, MA 01915 INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Netherlands Insurance Company 24171 INSURED Cranney Companies, Inc. Attn: Paul Cranney INSURER 9: North River Insurance Company 21105 INSURER C: New Hampshire Employers Insuran 13083 INSURER o: Excelsior Insurance Company 11045 10 Rainbow Terrace Danvers, MA 01923 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INR SUB D POLICY NUMBER POLICY EFF MM/ 0 POLICY EXP MM/00 LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE C OCCUR GEN'L AGGREGATE LIMIT APPLIES PER POLICY X PEO- LOC CBP8904118 3/2512016 03/25/2017 S1 OOO OOO pEACMHq�OEC7CURRENCE PREMISES Ea oau ante $30_0 ' 000 MED EXP (Any one person) $15,000 PERSONAL 6 ADV INJURY $110009000 GENERAL AGGREGATE 52,000,000 PRODUCTS - COMPIOP AGG s2,000,000 S D AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS X ALTOS X HIRED AUTOS X NON -OWNED AUTOS BA8904318 312512016 031251201 E°acccdEen SINGLE LIMIT 51,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peraccidanl S B X UMBRELLA LIAR EXCESS LIAR X I OCCUR CLAIMS -MADE 5811065496 3125!2016 03/25/2017 EACH OCCURRENCE $10,000,000 AGGREGATE S10,000,000 DED X1 RETENTION $O $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y I N OFFICERIMEMBER EXCLUDED? � (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA ECC60040004772016A MA/NH 312512016 0312512017 X Q STATU- OTH- E.L. EACH ACCIDENT $1_,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) XXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx XXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XX)=XX=(XXXXMMXX=MXXXXXXXXX=MXXXXXXXXXXXX=(XXXXXXXXXXXxxxxmmxxxxxxxxxxxxxxx EVIDENCE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN XxxxxxxxXxXxxxxxXxxxxxxxxxxxxxxx ACCORDANCE WITH THE POLICY PROVISIONS. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx AUTHORIZED REPRESENTATIVE Cil 'e el •' ©1988-2010 ACORD CORPORATION. All rights reservec ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3214521M321269 JNM XX) ;XX' i :XX) ,XXI 4 C.ommonweafth o� fi%ad�acett� Official Use Only 2epartment 013lre services Permit No. BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07j Occupancy and Fee Checked leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeC), 5 7 CMR 12.00 (PLEASE PRINT ININK OR AL INFORMATI ) Date: - City or Town of. To the Inspector of Wires: By this application the undersigned rues tics r her intention to perform th ctri�;c�al work described below. Location (Street & Nuknber) , -I ® E „( I V _ fir- � A 9� \ ) Owner or Tenant ��\ �Q�� v Telephone No. Owner's Address-- Is this permit in conjunct' n with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building A " a I Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Locat'on and tur f Proposed Electrical Work: i bp (2A Com letion o the o owin table may be waived b the Ins ector o Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above EJIn- Pool rn rnd. ❑ oo mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number " Tons " """"""' ' KW —..""'".." No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW ecurity Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts �6 Data Wiring: . No. of Devices or ENuivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring. No. of Devices or Equivalent OTHER: AL Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: — Ins tions 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 cov age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE EZ BOND ❑ OTHER ❑ t(Specify:) I certify, under andpenalties of perjury, that the information on this a plication is true and complete. FIRM N E: �C� -I LIC. NO.: Q Licensee: Signature LIC. NO.: (If applicable, ter "exemp " in the icen n er I- ),4 Bus. Tel. No. • �- Address: Alt. Tel. No.: *Per M.G.L. c. 147,-S. 57- 1, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) El owner ❑ owner's agent. j Owner/Agent PERMIT FEE: $ Signature Telephone No. 12eC�� ' The Commonwealth of Massachusetts Department oflrlduslrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www-maS Workers' Compensation Insurance Affidavit.-sBu Builders/Con s/Con Applicant Informationtractors/Electricians/Plumbers Name (Busiiiness/organizatio ndividual): Please Print Le ibl Address: -0r)Q Are you a---- --- • T � � � � i t . 1..1 ' ` n employer? Check the appropriate box: Phone #: 1 • ❑ I am a employer with 4. am a general contractor Type of project (required): employees (full and/or Part-time).* 2. ❑ 1 am a sole proprietor and 1 have hired the sub -contractors 6 New construction or partner- ship and have no employees listed on the attached sheet. These sub -contractors have . Remodeling working for me in any capacity. [No workers' employees and have workers' g' ❑Demolition comp. insurance�omp. required.] insurance.+ 9. El Building addition 3. ❑ 1 am a homeowner doing all work 5. E We are a corporation and its officers have exercised their 10.[] Electrical repairs or add' ' tttons myself. [No workers' comp. insurance right of exemption per MGL 11.[] Plumbing repairs or additions required.] t c. 152, § 1(4), and we have no 1) 11 of r pairs employees. [No workers' 13. Other�; 14 Any applicant that checks box #I must also fill out the section below eow ng their workers' t Homeowners who submit this cmpensation policy information. affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit ' Contractors that check this box must attached an additional sheet showing the name of the subcontractors w employees. If the sub -contractors have t Indicating such. employees, they must provide their workers' comp. policy number. I ar and state whether not those entities have n an employer that is providing workers' comp Information. I\ ensation insurance for my employees, A w� . w Insurance Company Name: Policy # or Self -ins. Lic. Job Site Address: Below Is the policy and job site Expiration Date: --- ? — 5 tt Attach a copy of the workers' compensation policy declaration pag— a (showing the Policy number and expiration��/ n� Failure to secure coverage as required under Section 25A of MGL -'c. 152 fine u to $1, date). UP 500.00 and/or one-year imprisonment, as well as cir I penalties in theformof a STOP WORK ORDER mposition Of criminal penalties nd a fine Of up to $250.00 a day a ainst the violator. Be advised that a cofy of this statement may be forwarded to the Office of Investigations of IA r insurance coverage verification. I do Itereby r9perjury "a't/re Information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority (circle one): Permit/License # 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other p Contact Person: Phone #: ACORP. CERTIFICATE OF LI) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, I BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMP RTANT: If the certificate holder Is an ADDITIONAL INSURED, the the terms and conditlons of the Policy, certain policies may require an I certificate holder In lieu of such endorsement(s). PRODUCER Duffy Insurance Agency, Inc. 317 Broadway Wyoma Square Lynn, MA 01904-2602 INSURED RAM Electrical Contract ng & Consulting Corp, 42 Pleasant Street Suite C Stoneham, MA 02180 OILITY INSURANCE DATE(MMIDD/YYYY) 02/10/2015 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS XTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED I011cy(les) must Do endorsed. If SUBROGATION IS WAIVED, sub ect to ndorsement. A statement on this certificate does not confer rights to the NAME: PHONE A/C No Ext: 781. S93. 1200 ac No ; 781.593.7260 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC 0 INSURERA: Arbella Protection Insurance INSURER B: INSURER C : INSURER 0: INSURER E: INSURERF: vVvr_RAUrz CERTIFICATE NUMBER: 000000 REVISION NUMBER: THIS IS TO CERTIFY THAT THE PO IES OF 1 SURANCE LISTED ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE AIJUE ISR WVD POLICY NUMBER GENERAL LIABILITY MM/DD MMIOD LIMITS COMMERCIAL GENERAL LIABILITY 850004170 12/18/2014 12/18!2016 EACH OCCURRENCE $ • 1.00 X CLAIMS -MADE XM OCCUR PREMISES Ea occurrence $ 10 A MED EXP (Any one person) $ GENL AGGREGATE LIMIT APPLIES PER: X POLICY P D LOC AUTOMOBILE LIABILITY ANY AUTO A ALL OWNEbX SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS X UMBRELLA LIAR X OCCUR A EXCESS LIAB CLAIMS -MADE DED X RETENTION $ 10, 0010 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN DESCRIPTION OF OPERATIONS / LOCATIONS Electrical contractors CERTIFICATE 12/18/201411 N/A (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) PERSONAL 8 ADV INJURY .11000,00 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per accident $ S EACH OCCURRENCE $ AGGREGATE $ E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ ANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE XPIRATION DATE THEREOF, NOTICE WIL E DELIVERED IN CO ANCE WITH THE POLICY PROVISIONS 1 1,000 1,000 ACORD 26 2010!06 f �"�� �y „�Vav�v yrwp Ivp.yAn rlghts reserved ( ) The ACORD name and logo are regi ed marks of ACORD / ( / A� �'' CERTIFICATE OF LIABILITY DATE(M12/15YYY) INSURANCE 08/12/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services, Inc of Florida 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 CONTACT NAME: Aon Risk Services, Inc of Florida MUM: AIC No Ext): 800-743-8130 AIC Noi: 800-522-7514 ADDRESS: ADP. COI. Center@,Aon.com MED EXP (Any oneperson) $ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: New Hampshire Ins Co 23841 INSURED ADP TotalSource FL XVI, Inc. INSURER B: 10200 Sunset Drive Miami, FL 33173 INSURER C INSURER 0: ALTERNATE EMPLOYER Ram Electrical Consulting & Contracting Corporation 42 Pleasant Street, Suite C INSURER E Stoneham, MA 02180 INSURER F GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ PROJECT EILOC ROTHER RGY101VI\ IlumoCn: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. INSR TYPE OF INSURANCE SUBR POLICY EFF POLICY EXPLTR SR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YWY LIMITS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE fADDIL COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL 8 ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ PROJECT EILOC ROTHER GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BODILY INJURY Pererson $ -- BODILY INJURY Per accident $ Per accident $ UMBRELLA LUIB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEC I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA X WC 034128395 MA 7/1/2015 7/1/2016 PER OTH- X S TATUTE ER E.L. EACH ACCIDENT $ 2,000,000 (Mandatory In NH) if yes, describe under E.L. DISEASE - EA EMPLOYEE $ 2,000,000 DESCRIPTION OF OPERATIONS below I E,L. DISEASE - POLICY LIMIT $ 2,000,000 FF DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) WAIVER OF SUBROGATION IN FAVOR OF CERTIFICATE HOLDER AS RESPECTS OF JOB PERFORMED BY RAM ELECTRICAL CONSULTING 8 CONTRACTING CORPORATION AS REQUIRED BY WRITTEN CONTRACT. All worksite employees working for RAM ELECTRICAL CONSULTING 8 CONTRACTING CORPORATION, paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy. RAM ELECTRICAL CONSULTING 8 CONTRACTING CORPORATION is an alternate employer under this policy. Re: 0 H Burg Corp. 181 Tosca Drive, Stoughton, MA 02072 A------ �Tr • ' CONCFI 1 aTIf1N W !%PUU-ZU14 AL;UKLI GURPURATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ��>n �L4IC ,�G?CYLC�Ss SRC O�(�ifi71'[LatZ W !%PUU-ZU14 AL;UKLI GURPURATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD "`SSUES THE,JOLLO1 ING 3CEN'SE AS aA R G9 a jD MAStER • ELECTR I C f Ao • RAM tLECTRICAL .CONSULTING CONTR �tOBRT ,>A. N 42 PLE�4S�C1Vt 57 u Tc Ek"AM i AA 02180-3850 to = 0 .3.1/4 ".'66074 A Date.... `........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thatDupwev–vtyz-Q—/ (I���, ' �V-evl .................................................................................................. has permission to perform .. ................................................. X c �'1 ....................................... wiring in the building of......`A, ....................�.t..........�^^...S.... ............................................ atUU t .............................,Li.d� .................d .. rth An ......................... dover, Mass. MM Fee... r..2 ............ Lic. No.11'?.3 ...l.....1. ...... .................... ...... . EL TRICAL INSPECTOR Check # t - Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy. and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev- 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM .ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL WFORMATION) Date: %— 14 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) %U C h tC k �l a t,nJ Owner or Tenant R ii V1 C W ✓11 p 2 iT S �� (-10--\5, Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes,1v ❑ (Check Appropriate Box) Purpose of Building 1� EQ C. L � () 0 � C � J?%�%�Tt(il`ityuthorization 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: D fl-� �t�,;-u !,L r --- Z.- __J i.. 7 r I errs. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans c /Yu{YGu V G/{G lLLJ GC�LV/ U rrtreJ. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ nd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat PumpNumber Totals: Tons """..* .... *-J-------*- KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal [J Other Connection No. of Dryers No. of Water Imo' Heaters Heating Appliances I(W No. of No. of Signs Ballasts Security Systems:* No. of Devices or Equivalent D Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: l F—A -y-\ c a C, Attacn additional detail Y desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: o� 0 0 0 (When required by municipal policy.) Work to Start: r ftnless Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties ofperjury, that the infor .oration on this fpplication is true and complete FIRM NAME: (Nl 0 v1`L K�'. V 1 C'► V\_ LIC. NO.: 1 '?5 3 -7 Licensee: 2 Ll - + ,n rn 00►2 CSignature LIC. NO.:L7 3a-;103 (Ifapplicable, enter `exempt" in the license number line.) U �/ us. Tel. No.•(,.-> 1 `l —t/ -7 Address: of .. u Z IQ yN y1\ y 1,.t/ , /'),4 ✓ls Lo "114 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the 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: $1 Z r-3 ''�- F nn 'V - EEECTd]MINSPECTOR- 1. KOUGA.M" CTION; Pissed-� [ ] -Failed-- j Re -inspection xegtd ecT($50.00) . [ .Inspectors' comments: - (xusp ectoxs7 Signafuxe •• no initials) Date 2. I+XIV•.� �7SPECTZ01.�1•; rassed - ate-3uispeciionxequiureci ($50.00)- [ lnspecta omm�enfs: (frispectbks' Sz afore no inftfaIs) Dafe 3. UNDER CROUM INS TECTION: passed--[ ] I+affed--[}2e-inspeetzoxtaequirecT($50.00)�[ ] Inspectors' comments: (Inspectors} Signature •• no initials) Date D ® OR TAG,5 ARE TO BE ED OU—T AND LEFT 0N BITE IF THE :A_PXA TO BE ENSPECTUD B NOT ACCESSIBLE AND AEE INSPECTION OF _S50.00 IS TO BE CHARGED. - The commonwealth of Massachusetts - Department oflndustriglAceid nts Office of.Divestigations 600 Washington Street ooston, .MA 02111 www mass gov1dia Worke& Compensation Ynsurance Affidavit: Buffders/Contractors/.EXcctriciansIPI=bexs M -.en VviH n+7.Puffili am I Address -U r4 H //r / City/State/Zip: S i 116 L /i �i ahone #• t� (_7 Are your an employer? Check the appropriate box: 1. ❑ I am a employer with J 4. El am a general contractor and I have hired the sub -contractors to ees full. and/orpart-time).* listed on the attached sheet. t 2, [P"r am sole proprietor or partner- [P -ram ship and have, no employees These sub -contractors have working forme in any capacity. workers' comp. insurance. 5. ❑ We axe a corporation and its [No workers' comp. assurance officers have exercised their required.] 3111 am a homeowner doing all work right of exemption per MGL g and myself. [No workers comp. c 52, § 1(4) e have no employees. o workers' insurance required.] i comp. insurance required.] t UJC�51 ►1C Type orproject (required): 6. [] Now cOnstruction 7. [] Remodeling S. [( Demolition 9. ❑ Building addition l0.[] Electrical repairs or additions 11. F] plumbing repairs or additions 12.❑ Roof repairs l3.[] Other Wy applicant that checks box#i must also fill out the section below shoY>he!r workers' compensation policy information. i'Homeowners who submit this affidavit indicatingthey R' doing all worX and then hire outside contractors must submit a new affidavit indicating such. Tr, , ,.,faro that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. X am an employer' that is pYoviding woliters' compensation insurance for my emvloyees. Below is the policy and joie site information. Insurance Company policy 0 or Self -ins. Lic. Expiration Date: job Site Address: City/State/Zip: Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,50 0.00 and/or one-year imprisonment, as well as civil: penalties in the form of a STOR WORK ORDER. and a tine of zip to $250.0 0 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office- of Inbestigations of the DIA for insurance coverage verification. X do it y ce i y. ader� lite pains anti enaIt' s ofperjury that the information provided alcove is true and cornett - � — � pate.- / D. • I _ G ^ ^ �_ (::� -y-70 `3-r-), Official use only. Do not write in tins area, to he completed by city or town official. Permit/License 0 City or Town. issuing Authority (circle 611e): 1. Board of Health 2. BuiidingDepartment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person:, Phone elm 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 ox written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two ormore of the foregoing engaged in a joint enterprise, and including the legal representatives of a•deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein., or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) andphonenumber(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LL C or LLP does have employees, apolicy is required. De advised that this affidavit maybe submitted to the Department of Industrial Accidents fog 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 ifyou 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 affidavitis complete and printed legibly. The Departmenthasprovided aspace atthebottom 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 submitmultiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "fob Site Address" the applicant should write "all locations iii (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. Anew affidavit must be fifilled out each year.Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOTrequired to complete this affidavit. The Oi`dce 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 anal fax number: Tho Co oxtwoalthofMassachwottq Depaxieut QfladuMal AQoldouta Ofte offavestigatxom CQG wa gtaa stxeat Boston MA. 02111 Tel, #617-7-27-4900 opt 406 ox 1-877, SASS.AFB Revised 5-26-05 Fax # 61M27-7749 _WWW-Mangov/dia "OMMONWE) LTH OF A. s"TT • On *:$.,I DU 0 ... .... .. .. . ....... ......,BOARUOf IVECTR I C I SSUES THE:.: FOLLOW I NG:..:L':! UNSE A 5,7.. I.S.Y4 S .R'-EGj: ERED MASTER ..-,DARWIN I - MOORE,... 9 SUZANNE*-" LN .. ... .... ... .. x..4 N SE LD . ... ... A 02048-34'8*7 ... -!:0`7/.3>1/°1;`>:`<<;>' 58211753;.'<{t<:<> 9 4 : b8 088�b QQ bli Vbb ZL O �o �"i g`��ioH$maSwr' i E -l: RIP i%; 14 a� 0 hU2� y$ 1 � �ee�a�•o� � 1 � I i � m 1 $ ���a - � g c Apr 12 07 11:438 Michael McGuirc �:Icrlu� lfnifda+� i:A7fJS13KrlRltFr October 13, 2005 NORTH ANDOVER 9786889542 't'DV1 N1 4)1 N(IffFII A S D 0 V.ER t;rce (if file Buiie;in-A Departo>men! i-ornmraz.v Deveh)p ent and Services :titrr ljN�t�l►tI 4Stt�i P.3 NORTH 0���.a• y�r4 P� 'JI�J�'pl�f1:1C i9 �.ti` i i�.",Y,•�,;:ati Latttiatr 8 Watkinl 850 Tsmn Center Drive 2e Floor Caste Mesa, CA 92020 in reference to the property to ed at 70Qa Town of North Andover, MA states' The current zoning district Is R5, arid en Assisted Living Facility is a permitted use in this district. A site plan was approved for this pmpwW several years ago when It was developed. A amlocate of occupancy was Issued for this property and Is attached. This Property does rat hove any outstanding zoning or building code violations. sincerely, Michael McGuire Interim suang Commissioner sag r ffnw..74" 04/11/2007 12:13 4056402608 PZR PAGE 01/06 The Planning & Zoning Resource 100 NEE 5�Street Oklahoma City, Oklahoma 73104 Telephone (405) 840 4344 Fax (405) 840 -2608 Toll -Free 1-(800)-344-2944 Toll -Free Fax (888) 523-9008 Attention: d 15rQ w FAX: 1Qq� �a Date: 2007 Number of Pages—_U , (htclu Ong COvfr vase) 9/10 Subject: Request For Information menage: From the desk of: Liz Taylor Information Specialist Boo -344-2944 ext 3258 Direct Fax 4 (405)418-2232 Proleetsftzr.corn 04/11/2007 12:13 4058402608 PZR PAGE 02/06 4 Resource Corporation 100 NE 51m Street • Oklahoma City, Oklahoma 73104 Telephone (405) 840-4344 • Fax (405) 840-2608 Toll Free (800) 344-2944 • Toll Free Fax (405) 840-2608 To: Gerald Brown Date: March 15, 2007 Subject: Zoning Verification Letter, (Formal Letter Form) Zoning Variances Zoning Violations Building Violations Site Plan Certificates of Occupancy Ashland Farms at North Andover 700 Chickering Road North Andover, MA We have been engaged to prepare a due diligence Zoning Analysis and Site Summary report for the above-mentioned site. Please consider this a formal .request for a letter outlining the Zoning Designation and a Brief Description of the property, as follows: •S What is -the current zoning of the property? 4. Is the property in any special, restrictive or overlay district? r• What are the abutting zoning designations? f• Was this a Planned Unit Development? If so, can we please get a copy of the PUD? fi Was this property granted any variances, special exceptions, or conditional use permits or zoning relief of any kind? If so, can we please get a copy of them? If these are not available, would you briefly outline the conditions of the applicable document? +:• Are there any outstanding zoning or building violations associated with this property? ❖ Are there any legal nonconforming issues? •S Was this property developed with Site Plan approval? if so, could we get a copy of the approved site plan and/ or approved regulations? Please sec attached form letter. Please copy onto your letterhead and indicate which of the three options applies to this site. Please sign and return by fax to me at the number listed above. 04/11/2007 12:13 4056402608 PZR PAGE 03/06 It is my understanding that there will not be a fee associated with this request. Please advise me immediately if this is incorrect. Please be advised that any costs associated with this request must be approved, in writing, prior to their incurrence. Please provide as much information as possible in writing. If there are any questions you are unable to answer, please let us know whom we should contact. Because we are working on a very strict timeline, we further request a faxed copy of the letter prior to its being mailed. Our client has asked that we gather this information as quickly as possible so any help would be greatly appreciated. Thank you in advance for your time and consideration on the above matter. If you have any questions or concerns, please do not hesitate to telephone at the toll &ee number above, extension 3248. Sincerely: Liz Taylor Information Specialist Direct Fax # 405418-2243 04/11/2007 12:13 4058402608 The Ptanni PM _ & Zoning Resource Co 100 NE 5 Street • Oklahoma City, Oklahoma 73104 Telephone (405) 840-4344 • Fax (405) 840-2608 Toll Free (800) 344-2944 • Toll Free Fax (405) 640-2608 Planning and Zoning Resource Corporation Attn: Liz Taylor 100 NE 5'' Street Oklahoma City, OK 73104 To Whom it May Concern: Based on our records [choose one] A valid final certificate of occupancy has been issued and is now outstandingfor the Project, (See Attached Copy ITsued) PAGE 04/06 TL Certificates of Occupancy for projects constructed prior to the year are no longer on file with this office. The Project was constructed in . The absence of a certificate of occupancy for the Project will not give rise to any enforcement action affecting the Project, A certificate of occupancy for the Project will only be required to the extent of any construction activity (.ruck as either restoring, renovating or expanding the Project or any part thereon. We are unable to locate a certificate of occupancy for the Project from our records. We have evidence in our records however, that one was issued and has been subsequently lost or misplaced. The absence of a certificate of occupancyfor the Project will not give rise to any enforcement action affecting the Project. A. certificate of occupancy for the Project will only be required to the extent of any construction activity, either restoring, renovating or expanding the Project or any part thereof. There are no Certificate of Occupancy issued for this Project and no enforcement will take rise to the property. The absence of a certificate of occupancy for the Prefect will not give rise to any enforcement action affecting the Project. Please call the undersigned at if you have any comments or questions. Sincerely By: Printed Name: (Title of Government Official) The Planning & Zoni Resource Corporation 100 NE 5 Street Oklahoma City, Oklahoma 73104 Telephone (405) 840 4344 Fax (405) 840 -2808 Toll -Free 1-(800)-344-2944 TolWree Fax (888) 5239008 Company: City of North Andover Attention: Gerald Brown FAX:9f 78) 88845-42 Date: 4113/07 Number of Pages 2 (Indudkv cover Page) Subject: 700 C kft . Ro d Message. Attached is the letter you did for us for the OMMO y listed above. lust have a small favor our client has asked of us. it has come to our attention from your office that Mr. Michael McGuire no longer works there. Can IMU Please send a revised - uo to date letter from your office with the information co fined in the original from r. McGuire. In the ' inel le tes that the roe is a�Assisted Living Foci/itY and that It is a aermitted use in diA ct "R5". Under the current code Assisted Living is not a listed gle and Nursing & Convalescent Homes are ogM tted with a Special Pe it. I need to know which it is how o about it and if the statement r�eardino violations are still accurate. Please let me know if You can do this and d so can you fox it back to my direct Me gated below. Thanks so much for all your MI Gionnette From the desk of: Glennette Koon, PZR Zoning Analyst 800-344-2944 ext. 3355 888-523-9008 toll free fax 4o5-418-2649 Direct Fax glennettek&xr corn 04/11/2007 12:13 4058462608 PZR The Planning & Zoning Resource Corporation 100 NE 5 Street Oklahoma City, OK 78104 Telephone (406) 840-4344 Fax (40S) 840-2608 Toll Free (800) 344-2944 Certificates of Occupancy Issuance for Ashland Farms at North Andover We have been engaged to prepare a zoning report with regard to the above site. As part of this report, it is our standard practice to include answers to the following questions so that we may accurately determine the status of occupancy on site. 1. How does the City Issue Certificates of Occupancy for: (please circle all that apply) Single Tenant Buildings: Multiple Tenant Commercial Building: Apartment Complexes: Shopping Centers: Shells Tenants Both Shells Tenants Both Shells Tenants Both Shells Tenants Both Z. When is a New Certificate of Occupancy required for: (please circle one far each) PAGE 05/06 3. If a Property does not have a Certificate of Occupancy on file, would that put the Property in violation? (please circle) yes no 3a. If yes, what would need to be done to take care of the violation? Single Multi -Tenant Apartments Shopping Tenant Commercial Complexes Center Change of Use yes no yes no yes no yes no Change of Owner yes no yes no yes no yes no Change of Tenant yes no yes no yes no yes no Tenant Improvements yes no yes no yes no yes no Renovations/Remodels yes no yes no yes no yes no PAGE 05/06 3. If a Property does not have a Certificate of Occupancy on file, would that put the Property in violation? (please circle) yes no 3a. If yes, what would need to be done to take care of the violation? (RHONE CALL t NORTH TOWN OF NORTH ANDOVER O e�1"110,6,• °oma OFFICE OF BUILDING DEPARTMENT 1600 Osgood St North Andover, Massachusetts 01845 Gerald A. Brown Inspectors of Building TO: Liz Taylor FAX: 405-418-2232 DATE 4/12/2007 FROM: Jeannine McEvoy for Gerald Brown, Inspector of Buildings TEL: 978-688-9545 FAX 978-688-9542 Liz, Tel: (978) 688-9545 Fax: (978) 688-9542 Per your request I am sending you documents relative to Ashland Farms that are contained in our files. If you have any further questions please call. BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 HP Fax K1220xi Last Transaction Date Time Tie Identification Apr 12 11:42am Fax Sent 814054182232 Log for NORTH ANDOVER 9786889542 Apr 12 2007 11:48am Duration Pages Result 2:00 9 OK v4/11/(887 12:13 4058402608 The Planni PZR & Zoning Resource Co. .,y, 100 NE 5'm Street • Oklahoma City, Oklahoma 73104 Telephone (405) 840-4344 • Fax (405) 840-2608 Toll Free (800) 344-2944 • Toll Free Fax (405) 840-2608 Planning and Zoning Resource Corporation Attn: Liz Taylor 100 NE e Street Oklahoma City, OK 73104 To Whom it May Concern: Basedonour records [choose one]: �' A valid final certificate of occupancy has been issued and is now outstandingf or the Project, (See Attached Copy Issued) PAGE 04/06 .M Cert 0cates of Occupancy for projects constructed prior to the year are no longer on file with this gf%e. The Project was constructed in The absence of a certificate of occupancy, for the Project will not give rise to any enforcement action affecting the Project, A certificate of occupancy for the Project will only be required to the extent of any construction activity (such ar either restoring, renovating or expanding the Project or any part thereon. We are unable to locate a certificate of occupancy for the Project from our recor&T. We have evidence in our records, however, that one was issued and has been subsequently lost or misplaced. The absence of a certificate of occupaneyfor the Project will not give rise to any enforcement action affecting the Project. A certificate of occupancy far the Project will only be required to the extent of any construction activity, either restoring, renovating or expanding the Project or any part thereof. There are no Certificate of Occupancy issued for this Project and no enforcement will take rise to the property. The absence of a certificate of occupancy for the Prgjeet will not give rise to any enforcement action affecting the Project. Please call the undersigned at if you have any comments or questions. Sincerely 13y: Printed Name: (Title of Government Official) 04/11/2007 12:13 4058402608 PZR PAGE 06/06 4. How long has the City been Wowing Certificates of Occupancy? S. How .far back do your records go for: Ccrtificates of occupancy / 9 9151 Building Permits j G. Are your records kept on: (please circle all that apply and how far records go back) Computer: Paper: t/ Microfilm: 7. es the Building Department perform annual Building Inspections? 7no (please circle) 7a. If not, does the Fire Department perform annual inspections? yes no (please circle) Thank you in advance for your time and consideration on the above matter. If you have any questions or concerns, please do not hesitate to telephone at the toll f'rec number above, extension 3248. Sincerely, Liz Taylor By: Printed Name: Title: (Title of. Government Official) It is my understanding that there will not be any fees associated with filling this request Please advise me immediately if this is incorrect. Please be advised that any costs associated with this request must be approved, in writing, prior to their incurrence. 04/11/2007 12:13 4058402608 PZR PAGE 01/06 Attention The Planning & Zoning Resource 100 NE 51" Street Oklahoma City, Oklahoma 73104 Telephone (405) 840 -4344 Fax (405) 840 -2608 Toll -Free 1 {800)-344-2944 Toll -Free Fax (888) 523-9008 FAX: Date: �Oft_ IOJ , 2007 Number of Pages -_U . (Wlu ng cover vW90 00 a Subject: Request For Information _ p Il�kssage: From the desk of: Liz Taylor Information Specialist 8003442944 ext 3258 Meet Fox 8 (405)418-2232 Proleets@mr.com 04/11/2007 12:13 4058402608 PZR PAGE 02/06 Zoning Resource Cor / The Planning & Zo oration p 100 NE r Street • Oklahoma City, Oklahoma 73104 / 40-4344 • Fax 405 840-2608 Telephone (405) 8 ( ) Toll Free (800) 344-2944 Toll Free Fax (405) 840-2608 To: Gerald Brown Date: March 15, 2007 Subject: Zoning Verification Letter, (Formal Letter Form) Zoning Variances Zoning Violations Building Violations Site Plan Certificates of Occupancy Ashland Farms at North Andover 700 Chickering Road North Andover, MA We have been engaged to prepare a due diligence Zoning Analysis and Site Summary report for the above-mentioned site. Please consider this a formal request for a letter outlining the Zoning Designation and a Brief Description of the property, as follows: 4# What is -the current zoning of the property? + Is the property in any special, restrictive or overlay district? A What are the abutting zoning designations? Was this a Planned Unit Development? If so, can we please get a copy of the PUD? 0 Was this property granted any variances, special exceptions, or conditional use permits or zoning relief of any kind? If so, can we please get a copy of them? if these are not available, would you briefly outline the conditions of the applicable document? 4- Are there any outstanding zoning or building violations associated with this property? �►• Are there any legal nonconforming issues? •- Was this property developed with Site Plan approval? If so, could we get a copy of the approved site plan and/ or approved regulations? Please sec attached form .letter. Please copy onto your letterhead and indicate which of the three options applies to this site. Please sign and return by fax to me at the number listed above. 04/11/2007 12:13 4058402608 PZR PAGE 03/06 It is my understanding that there will not be a fee associated with this request. Please advise me immediately if this is incorrect. Please be advised that any costs associated with this request most be approved, in writing, prior to their incurrence. Please provide as much information as possible in writing. If there are any questions you are unable to answer, please let us know whom we should contact. Because we arc working on a very strict timeline, we further request a faxed copy of the letter prior to its being mailed. Our client has asked that we gather this information as quickly as possible so any help would be greatly appreciated. Thank you in advance for your time and consideration on the above matter. if you have any questions or concerns, please do not hesitate to telephone at the toll free number above, extension 3248. Sincerely: Liz Taylor Information Specialist Direct Fax 0 405418-2293 TOWN OF NORTH ANDOVER Office of the Building Department Community Development and Services 400 Osgood Street North Andover, Massachusetts 01845 Michael McGuire Interim Building Commissioner October 13; 2005 Lathan E & Watkins 650 Town Center Drive 20t` Floor Costa Mesa, CA 92626 Telephone(979)688-9545 FAX (97 8) 688-9542 In reference to the property located at IMCJddWftRoatAe Town of North Andover, MA states. The current zoning district is R5, and an Assisted Living Facility is a permitted use in this district. A Site plan was approved for this property several years ago when it was developed. A centriicate of occupancy was issued for this property and is attached. This property does not have any outstanding zoning or building code violations. Sincerely, Michael McGuire Interim Building Commissioner dumber: 7488 Building Permit Number_ 446 (1924)— Date A1,911s , Q 1995 THIS CERTIFIES THAT THE BUILDING LOCATED ON 700 CHICKERING ROAD - "THE HERITAGE" MAY BE OCCUPIED AS MULTI -FAMILY HOUSING FOR SENIORSIN ACCORDANCE 100 UNITS) WITH THE PROVISIONS OF THE MA �P YS�TS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS SEE REVERSE SIDE FOR OCCUPANCY LOAD. CERTIFICATE ISSUED TO ADDRESS N A Assisted Living Ltd. C.0 ADS Senior Housding St. Cambridge, MA 1 Building Inspector Offlce of the t-61dingDepartment Cont3ity DeYelopr[entand el1&/e s 4100 05go'.)d Str et lasswlwseft-- 018415 Michael McGuire 31:Ftr.'.rinn nnihlilkg co"f le +fi:S'.yho n 4'x' October 13, 2005 Latham & Watkins 850 Town Center Drive 2& Floor Costa Mesa, CA 92626 ;,- 4 5 1 `.`iii (97. ;;. Irl reference to the property located at 700 Chickering Road, the Town of North Andover, MA states: Tib currant zoning district is R5, and an Assisted Living Facility is a permitted use in this district. A Site plan was approved for this property several years ago when it was developed. A tortifleate of occupancy was Issued for this property and is attached. This property does not have any outstanding zoning or building code violations. Sincerely, Michael McGuire Interim Building Commissioner silo number: 7488 CE AN CY+ Building Permit Number 446 C14�_ Date Arust IR '19:9 THIS CERTHiES THAT 700 CHICKERING ROAD THE BUILDING LOCATED ON - "THE HERITAGE"' AS MULTI -FAMILY HOUSING FOR SUNITSSIN ACCORDANCE MAY BE OCCUPIED 1 • • ) WITH THE PROVISIONS . OF THE MASSACHUSETTS STATE BUILDING CODE AND` SUCH OTHER REGULATIONS AS MAY Ar PLY - SEE REVERSE SIDE FOR OCCUPANCY LOAD. p0NTl1 N A Assisted Living Ltd_ o���.. ,�,tia CERTIFICATE ISSUED TO C, 0 ADS Senior Housding a MA FADDRESS Cambrid 0 -0-a • ,,J,�NusBuilding Inspector #4 `own T of Nrorth . Andover AN CY+ Building Permit Number 446 C14�_ Date Arust IR '19:9 THIS CERTHiES THAT 700 CHICKERING ROAD THE BUILDING LOCATED ON - "THE HERITAGE"' AS MULTI -FAMILY HOUSING FOR SUNITSSIN ACCORDANCE MAY BE OCCUPIED 1 • • ) WITH THE PROVISIONS . OF THE MASSACHUSETTS STATE BUILDING CODE AND` SUCH OTHER REGULATIONS AS MAY Ar PLY - SEE REVERSE SIDE FOR OCCUPANCY LOAD. p0NTl1 N A Assisted Living Ltd_ o���.. ,�,tia CERTIFICATE ISSUED TO C, 0 ADS Senior Housding a MA FADDRESS Cambrid 0 -0-a • ,,J,�NusBuilding Inspector #4 SENT BY: HUNT CONSULTING, INC.; 859 657 6677; SEP -30-05 3:19PM; PAGE 1/1 SENT VIA FACSTMILE 09-30-05 TO 978-688-9542 September 30, 2005 TO: City of North Andover North Andover, MA Facsimile No.: (978) 688-9.542 Attn: Mr. Michael McGuire Re: Ashland Form 700 Chickering Road North Andover, MA GaiaTech Project No. A2141-810-0-0 Gentlemen: GaiaTech is an engineering firm currently conducting a property condition survey of the above referenced property. As part of the due -diligence process we request your assistance by providing us with some information from your files. Through the Freedom of Information Act, we request your assistance by providing us with the following information concerning the site and buildings at the referenced property files: • Does your department regularly inspect the property and if so, when was the most recent inspection? Are there current, unresolved building code violations at the properly, and if so, can copies of the inspection reports/citations be provided? • What is the flood zone for the property (Please provide FEMA map panel and date)? • What is the building zoning for the property and does the development comply with that zoning? Thank you for your assistance in this matter. If you need additional information to comPlete our request, please contact me at 859-657-6677. Responses may be faxed directly to our office at 859-657-6677. Sincerely, GaiaTech Jeffrey A. Hunt Zoning -Info, Inc. 510 East Memorial Road, Suite B-1 Oklahoma City, OK 73114 Phone: 405.525.2998 Fax: 405.528.4878 Tuesday, September 20, 2005 Attn: Mr. Michael McGuire Re: Benchmark -North Andover 700 Chickering Rd We are preparing a Zoning Compliance Report on the above stated property. We are requesting a letter on City letter head stating if there are (or are not) any outstanding Zoning Code Violations on the above property. If there are current violations please provide us with copies of them. Thank you for your assistance with this Please address the letter to: HCP Investments 3760 Kilroy Airport Way #300 Long Beach, CA 90806 Sincerely, April Larman Research Specialist Site #: 7488 Please return the letter Zoning Info, Inc. 510 East Memorial Road Suite B-1 Oklahoma City, OK 73114 Phone: 405-525-2998 Fax: 405-528-4878 .f z O — W W > a ° U) zz z 0 Q o� ~L� Q�0 W z � Q Q W LL ♦n W W = 0 Q) co O c Y N a N r N U m CL 0 c N Rf t N L LL W U 4-0 tt Ilz e et u O a O U0 -C H � E-+ V LO 0 rrW H z O c O CJ N ~ cz) W O 00 (n � O Qm z x(1) U :c m O r -I O CJ �(n H Ov- w tv za) A p4 � W m cn O U a U c c Jcu U r 0 U �I N � 0 C z O — W W > a ° U) zz z 0 Q o� ~L� Q�0 W z � Q Q W LL ♦n W W = 0 Q) co O c Y N a N r N U m CL 0 c N Rf t N L LL W U 4-0 tt Ilz e et u O a O o� CD 0 N v �u Q U0 � V H z O O 0 W � O ° �y O r -I O CJ w tv tt A p4 o cn U a U U 0 o a �o z z z 0 0 >' M n V A o� CD 0 N v �u Q � V O O O W � � ° �y O O N O CJ w tv tt A p4 o cn a o� CD 0 N v �u Q I D. Robert Nicetta, Building Commissioner TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax (978)688-9542 CONTROL CONSTRUCTION — SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 I, Michael T. Stott .HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 Chickering Road, North Andover, MA 01845 DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: DATE: 09/27/2013 REGISTRATION: Massachusetts Reg. No. 31445 NOTE: ENGINEER "WET STAMP" MUST BE AFFIXED TO THIS FO Control Construction Form revised 11. 15.2004 BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 A D. Robert Nicetta, Building Commissioner TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax (978)688-9542 CONTROL CONSTRUCTION — SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 1, Michael T. Stott ,HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 Chickering Road, North Andover, MA 01845 DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: DATE: 09/27/2013 REGISTRATION: Massachusetts Reg. No. 31445 NOTE: ENGINEER "WET STAMP" MUST BE AFFIXED TO THIS Control Construction Fonn revised 11.15.2004 BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Date ... 4.....�d � ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING t��LieAeic, Thiscertifies that ...................... ....................................... ....]......(........................... has permission to perform ...LiAu Illi...��1�1'L-1L ......... ...................... wiring in the building of...... .� ............. at ............... A...... I.... `� .:............... orth Andover, Mas . Fee..... P.5 .. Lic. No321.0 ... ..:!......... l ...... . ... .. ......... ... ... ELECTRICAL INSPECTOR Check 0 �� �� f Commonwealth of Massachusetts Department of Fire Services , BOARD OF FIRE PREVENTION REGULATIONS Official Use 0 y Permit No. v"I Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN HK OR TYPE ALL INFORMATION) Date:_j o — / City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) --� Qy e P, Owner or Tenant O�' h C N me R r r4 C 'I S i LI 1 Telephone No. Owner's Address S Gq m );:52- C_ Is this permit in conjunction with a building permit? Yes J�K No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters 1 -+ Number of Feeders and Ampacity D J:� M () E L & C' j C v41 t Location and Nature of Proposed Electrical Work: C 1/\�'z �l C f Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- 11o. rnd. rnd. o Emergency Lighting BatterUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: Number ,Tons KW.......... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Imo' Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or EQ uivalent OTHER: Estimated Value of Electrical Work: a� v Attach additional detail if desired, or as required by the Inspector of Wires. U (When required by municipal policy.) Work to Start: b ` Inspections to be requested in accordance with AMC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FUM NAME: Oe tJ i CIE C' t ✓t C f LIC. NO.: )�F 3 3 14 (q Licensee: RLu., ) Y ---j 1n O D eq Signature Q LTC. NO.: If applicable enter "exempt" in the license number line.) Bus. Tel. No.: d "3 ' 0 gC 3 Address:y? �Y, r l..N . _�✓1 K1y1S Ind' 0 0 �/ Alt. Tel. No.: l — l o ^ 3� 13 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: Tam aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No.Zj ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule S: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: ** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass V Failed Re- Inspection Required ($.) ❑ Inspectors Co me ts: /11 —7 'r Inspecto s Signature: Date: ROUGH SPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ .� Inspectors Comments: Inspectors Sig ture: Date: FINAL INSPECTI Pass n Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts 07 Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Uf www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): M 0 C)�e kL 1 L C C> S f - y ) n C Address: 5 v 2 Y-\ Y1 3\J $ City/State/Zip: rn A n5 7= k Lc- Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I _ employees (full and/or part-time).* have hired the sub -contractors 2. R�ka n as sole proprietor or partner- listed on the attached sheet. t ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. E] Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I F-Tomeowners who submit this affidavit indicating they dre 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; Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do h erqby—certify under the pains and penalties of perjury that the information provided above is true and correct. Silrilature - ``--- Date: G Phone #: v - F7 - � t 7 b - 3 :� 1 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 #: 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 employeris defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein., or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' 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 s 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, i please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth o£'Massa.,chusetts Department ofladustriai Accidents Office of Investigations 600 Washington Street Boston} MA. 02111 Tel, # 617-72.74900 ext 406 or 1-877�,MSS AFE Revised 5-26-05 Fax # 617-727-7749 www.Mass,gov/d is Date.VAA.(:)W ...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,j Thiscertifies that ......................................... .............. * ... .. n- .......................... has permission to perform... . ............... ...... plumbing in the buildings of..&A A� .... . .. I .... V ........................... at ......... C.6.1!A ..e ... I-- R ** j North Andover, Mass. FeeS6. a ..... Lic. Not M.1 ..... ....H0 ................................................................. Check # w - PLUMBING INSPECTOR 17-1 t (-) ` t -;j MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �I MA DATE r ] PERMIT # JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS e_ TEL � 13O FAX TYPE OR OCCUPANCY TYPE COMMERCIAL] EDUCATIONAL Q RESIDENTIAL QI PRINT CLEARLY NEW: Q RENOVATION: REPLACEMENT: N11 PLANS SUBMITTED: YES Q NOW FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ( f ( _(f [ I f ! _........ ! j [ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM E r„ ._�J -_ ! (-� _ — ! fIIE__ ..f DEDICATED GREASE SYSTEM ( V F __._. ___—! _._.___I _._ J —[ ______( f DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I _._____-j .._.._ j DISHWASHER DRINKING FOUNTAIN f ..-_-- (-_-_ � .____._[ ._._ � 1.._._._.( __..__i .__ _! ___.__I ...._..! ____.J ___.... ► _.____( _-- FOOD DISPOSER i ._... _! 1_.1 FLOOR/AREA DRAIN _l _____! .____ ► __. 1 ___ ! I _..._-�---__.I _. _.__4 ____ ._____( ___.__ ---.— f _..___( i'NTERCEPTOR (INTERIOR) [ _.._—I _--.-._l 4 KITCHEN SINK VATORY ROOF DRAIN! SHOWER STALL SERVICE / MOP SINK TOILET 1 __-_ f _ _ r __ I _ I _ _—� _-_ ___-• 1 _-_ _�t _.I __-- —_-_! URINAL WASHING MACHINE CONNECTION I (._. --_ # 1 __._.4 _. ._-.._.1 _ .._ . ! . _f _._ _ _[ .... WATER HEATER ALL TYPES i [ ------ [[ WATER PIPING ( [ ........I ._.__._1 OTHER _ _—� ! INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ;] NO Q IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Wi' OTHER TYPE OF INDEMNITY Q BOND Q 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. 2 CHECK ONE ONLY: OWNER .i AGENT (QE SIGNATURE OF OWNER OR AGENT true to the best knowledge hereby certify that all of the details and information I have submitted or entered regarding this application are and accurate of my and that all plumbing work and installations performed under the permit issued for this application will be in ian with all Pertinent provision of the 142 Laws. Massachusetts State Plumbing Code and Chapter of the General PLUMBER'S NAME snc� I LICENSE # ZRATURE IMP Q JP P] CORPORATION Q#PARTNERSHIPQ# LLC COMPANY NAME _rlf ADDRESS j�j �., ti� I CITY X - . _ -_j STATE �,,� ZIP Q Q 3 TEL FAXI tf.M(_ ( CELL �EMAIL------___--.---..----._---------..._..__.__.------------_._...___..----_....---_ __.__ ON tam" y ❑ u, M w LU LL The Commonwealth of Massachusetts Department of IndustriqlAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �S`7�cq\ S City/State/Zip: f`(� 0 2,�D Phone #: ffn �5 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 listed on the attached sheet, # �• [_1 Remodeling 2.3 I am a sole proprietor or partner - 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 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work ri ht of exem tion er MGL g p p 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' 13. ❑ Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. f Homeowners who submit this affidavit indicating they Lire 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 Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cel alnder the pains and penalties of perjury that the information provided above is true and correct. (f�A- ' CAA �^ - N\ a 11") 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 #: 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 including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-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 members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any cluestions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of ludustdal Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 61.7-727-4900 ext 406 or 1-877:MASSAFB Revised 5-26-05 Fax # 617-727-7749 vvww-mass,gov/dia COMMONWEALTH OF MASSACHUSETTS7-1 z LICENSED AS A JOURNEYMAN PLUMB I ISSUES THE ABOVE LICENSE TO: 4 JAMES 1 MCLAUGHLIN. r 1.55 CENTRAL ST im " Ftf:BORO MA 02035-2458 20881 05/01/14 161275' a) 4- 0 U)'0 N.c c Q. 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Select Parcels (show all) i Ower �Prop n_ID Ad BENCHMARK GPT NORTH ANDOVE 083.0-0001-0000.01701LR 1 selected To Mailing_ Labels To Spreadsheet Print ' Ownerl BENCHMARK GPT NORTH ANDOVER,L Owner2 C/0 200 CHICKERING ROAD N ANDOVE Address 700 CHICKERING ROAD PropertyID 083.0-0001-0000.0 Lot Size 7.85 A Fiscal Year 2013 Land Use 112 Code fA&*naCk Valley Suring Cdnrnslon does not InSke aAywanamy. expo or IiWW. rmr at%rne any kKO Leahy or re KW for me aowtery. carr,le'cahew. ,o.ua,.sa d the Geogrsprtc artd.nattdh Sysecm lGt9} ais n' any otterdatn povtdad neretn. The data does not take the place or a poteswrd suvey and has nn to Uewing en the nue Shap-- sae. bcatbn, oe ftWm ce of a gmgrapw Wire, poparty we6 orprJitkai mpeeentaon. Mernma k Vaaay Mannag Cotmis6on requests that eery uSe d ms traarmadrn be a=ffW Beed by3:Weranm to its some aro the I.Se"L' wk Vm" ftiudrg Cerrxntmion a caveat that ft makes no warhadtes or '� f r,p W talij=as to the acmracy a seid Infohatatim Any uses t`s ttotmaton is at the racgtehts own nA k " f, - 11 .http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx 1/31/2013 N° 9640 Datj -.!2 TOWN OF NORTH ANDOVER 3: � PERMIT FOR PLUMBING 40 ,SSACNUS� This certifies AN C— has has permission to perform ............... plumbing in the buildings o p 5!�......t.ck .. . at . )00 ..CG tC- k e�c lw . �.... North And er, ass. Fee. t Q. !�7Lic. No.� .. ..... PLUMBING INSPECTOR Check #�— WHITE: Applicant CANARY: Building Dept. PINK: Treasurer IF -CN MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - CITY MA DATE O ` ( PERMIT-#- JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS C _ TEL �m FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Q RESIDENTIAL Q PRINT CLEARLY NEW: E] RENOVATION: D REPLACEMENT: [ ] PLANS SUBMITTED: YES © NO FIXTURES'l FLOOR- BSM 1 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM • � � � � � � I�(1�91�I�i®�i�i1�h��i�il.��f® DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTEf KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER C- INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES F-11 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITYE11 BOND Q OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachuse�eeieral Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT J 1 NATURE 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�A�an with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ck, j,_ y�LICENSE # SIGNATURE - MP 0 JP CORPORATION 0# ( PARTNERSHIP # _ __ ' LLC - COMPANY NAME ADDRESS CITY _ ;cv _ STATE ( ZIP —, b s5 ;I TELI FAX _� ; CELL EMAI r r H � o w a, z � w � Nl . o z Fl z �El o �D W o a z u LLJ _ ~ �® co W 5 x CO a o LLI CO a p o a � w a � U J a IL a cn LL; zw I --LL rA W H z o H U W a CODz° z � x a P-4 x I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: eD5 cr_Ac,�`j City/State/Zip: ���j6co YYA, Phone #:-60'6 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. �fI am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11. EJ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *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 anew 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: Policy # or Self -ins. Lic. #: Job Site Address: Expiration 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. 1 do hereby cerfl rude he pains and penalties of perjury that the information provided above is true and correct. Z Gi VMVi Official tise 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 #: 0 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 including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-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 members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www,mass,gov/dia Date ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................. M.P. a. P—. 1. L..L ..... ................ ...... .. .... .... . .. ... ............. has permission to perform .. 6CA..l ia. �, ........................ wiring in the building of A��./, —,vr .......................... at.. 7,00 ................. rt Andover .................. ................... ........ /�b ............... . North And Fee..L.'/ Lic. No.5-00 J.. 7.� ��JW ...... .. ....... ....... Check # OLEMICAL IiN�S�PW�RX 104-84 Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: i 1 -11- I I - City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) —100 Chicbtrioa R00 -d Owner or Tenant Ashland (-a((Yl S (�iP1)C-Y) 1C rk njof ��vjMl Telephone No.gTb-(83-1?�(�(� Owner's Address -tco aiCKerinn h,(Dd Is this permit in conjunction with a building permit?i Ves ❑ No X❑ (Check Appropriate Box) Purpose of Building UYSif)GI YTUiYIe/Qtt. �I - ReSlden+rcJ 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: ln)-kd qyu redo box G)r commu✓Iicaftori to ` NerfVl /�ndo�2r ire �e rrme�tf- Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices Heat Pump Number I Tons KW No. of Self -Contained No. of Waste Disposers Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal g Other Connection No. of Dryers Heating Appliances KW SecuritNo. of De ices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail i�desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Jof WorktoStart: Il-0?1-ttInspections 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 X❑ BOND ❑ OTHER ❑ (Specify:) LiabdIN I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: kigrl it Re—CM o t r1 LIC. NO 7389 A Licensee: Call Ci. Wwri II Signature O.: (If applicable, enter "exempt" in the license number line.) Bus. I. No.:1gf8-3�-1523 Address: lye J- ave,rhi II QooJ , Ame5h-Lr, . kA A 61813 AI . el. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ r-41ci eZC 11-9-lz �, Date.. /jQ-z�' / Z This certifies that ..... N.QoE-..4Z.4Ce7Z -Foc- has permission to perform ..... R:t�- kcAe- L. ... (< c77kL.w. . wiring in the building of ... 13.&WC PL ORK................. !`-..� *. .......... , orth Andover, Mass. at . .7�VAFee A.�� Lic. No..A ......p .... .. . . ' . t. ELECTRICAL INSPECTOR Check #I -7,3E N Commonwealth of Massachusetts Official Use Only Permit No. REWME Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 7© D G� i c k 6 #71 ^;;- /Z Q Owner or Tenant _B e n c. H M A e k /,} S 5* ,1 57 e to L t V t Telephone No. Owner's Address ln/ C 11 S SSA C h v3 C ? S Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building D r r ��a �, 4 /°�� Utility Authorization No. - Existing Service New Service Amps / Volts Amps / Volts Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity 9 E 4- F—D S -T-0 1` 1� � � ��1 5 �i' t -v ►4 � � �%� Location and Nature of Proposed Electrical Work: 14/10 e- o c, -vi '-r ?9 2 e— i R C U 1 T S 1-: u f*b.. ! lln,.,;v n mblo mm? ha wnivvd by the Inspector of Wires. 0& Alracn aaamonat uetutt y ueaucu, vi "o .,y •..� -•• t _.-• v Estimated Value of Electrical Work: oOO (When required by municipal policy.) Work to Start: 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 covers e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, tinder the pains and penalties of perjury, that the informtation on this application is true and complete FIRM NAME:. oa t2 E Ci S V ' 17\C LIC. NO.: 7'�5 37 Licensee: Dq a2v i Y", M 40 i2 Signature LIC. NO.: )F— 3 .1-;-00 3 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.:.i'� y7 a 3 13 Address: 5 Su2nnnC- L, JJ, 1.462 - MA, 0aOV7 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. No. of Total No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires AboveIn- Swimming Pool rnd. ❑ rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets C2 No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges lHear No. of Air Cond. Total Tons No. of Alerting Devices p Number Tons KW.... "' Self-contained No. of Waste Disposers tm Detection/Alerting Devices De c No. of Dishwashers Space/Area Heating KW Municipal Other Local ❑ ❑ Connection No. of Dryers Heating Appliances Kms' Security Systems:' No. of Devices or Equivalent No. of WaterKW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Eg uivalent OTHER: 0& Alracn aaamonat uetutt y ueaucu, vi "o .,y •..� -•• t _.-• v Estimated Value of Electrical Work: oOO (When required by municipal policy.) Work to Start: 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 covers e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, tinder the pains and penalties of perjury, that the informtation on this application is true and complete FIRM NAME:. oa t2 E Ci S V ' 17\C LIC. NO.: 7'�5 37 Licensee: Dq a2v i Y", M 40 i2 Signature LIC. NO.: )F— 3 .1-;-00 3 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.:.i'� y7 a 3 13 Address: 5 Su2nnnC- L, JJ, 1.462 - MA, 0aOV7 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. kasseai�iaile[�jteuseciio� �eruixe (0.00) [ �t5�eat S' mmeJxts: . (nsiectoxs''zgn e. oto 'iiass) Pate 'assets—f I +azlets j) Re-Wpectzop,repirea(�So.U0) [ ) aspetoxs' comments. . stn sp ectoxs'ignaiuxe oitiaTs) Pate 0421, CAVfrm —0 NWUTONM� ssoa—[ ) pectbxs' eoxnme�tfisa Aailets-- (Zttspectoxs',�zgnatuxe w NAMI-C:. te�xnspectioxtxa actoxs' coxizm.�nfs: _ , • S ' Data ��spectoxs° Minatme -no initials) Date l2�sset��� �'aiiefl-�C T �e-i:nspseizon �'et�uixec�($�O.gU) � � � �nspectpxs' �apa�xte�ats: . lcvn" W�� •'t V* appeaforeBjgtta a-)ao Rials) ,- _plate kasseai�iaile[�jteuseciio� �eruixe (0.00) [ �t5�eat S' mmeJxts: . (nsiectoxs''zgn e. oto 'iiass) Pate 'assets—f I +azlets j) Re-Wpectzop,repirea(�So.U0) [ ) aspetoxs' comments. . stn sp ectoxs'ignaiuxe oitiaTs) Pate 0421, CAVfrm —0 NWUTONM� ssoa—[ ) pectbxs' eoxnme�tfisa Aailets-- (Zttspectoxs',�zgnatuxe w NAMI-C:. te�xnspectioxtxa actoxs' coxizm.�nfs: _ , • S ' Data ��spectoxs° Minatme -no initials) Date i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 5www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any appliyant 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: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as 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 )f up to $2j'00.00 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. r do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 3i gnature: Date: 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 #: 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 including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-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 members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia 1 Date ...... ./O- Z7 -o f . TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................................................................. has permission to perform S EG G �r"1... 5"`/..,1...� ............................. wiring in the building of ........... ��..W,� « ................. fly ���.�� rl /.-(iii nn/ at .... ...........:......... O............,......�C...�................. , North Andover, Mass. Fee .....y -'Lic. No..... .... .................... � 2� ..... � ECTRICAL INSPECT Check # 2 /6y -77z, IrL7 0fI-_�t, t Official Use C;nl— .__—_= :,nnu�wnwea iii o Y�a69at{iu5e�1 t(1 — It- J �7 Permit No. Vy-- -� : l � .,1.)ePar�tnc�nj o�}ire Jeruiced =- - _- Occupancy and Fee Checked _ BOARD OF FIRE PREVENTION REGULATIONS — - --� [Rev. 1/07] (leave blank) I APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the AMassachusetts Electrical Code (MEC), <7 Ci -IR '2.00 (PLEASE PRl:'VT Ill Lei. OR'TY 4LL IX-F'O L4TION) Date: City or T©�r-1a of: )Lk _ �/�,�, To the Inspector of'f'f'fres: By this application the undersigned gives notice of his or her intention to perform the electrical work described be?o'.v. Location (Street & Number)_n te/`I Owner or Tenant _� /] jL Or �•�rv��j I Lem I Telephone No. _ Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service _ Amps New Service —_ Amps Location and Nature of Proposed E Yes ❑ No ® (Check Appropriate Box) Utility Authorization No. / Volts Overhead ❑ Undgrd ❑ No. of Meters / _Volts Overhead ❑ Undgrd ❑ No. of Meters ' •- r TAttach additional detail if de�ir_,d, o• Ulic�:V:- Estimated Value of }lectrical Work: _ `t' _ (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C©/VERA, E: 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. CHECKONE: INSURANCE [Z BOND ❑ OTHER ❑ (Specify:) Self Insured I certify, under the pains and penalties ojperjury, that the int rmation on this application is true and complete. FIRM NAME: ADT Security Services LIC. NO.: C Licensee: Mark A. Brophy _ Signature LIC. NO.: C-45 _ (If applicable, enter "exempt " in the license number line) Bus. Tei. No.: 603-_E,94-5928 Address: 18 Clinton Drive 'rollis, NH Alt. Tel. N'o.:__. _ *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 00953 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature _ Telephone ;No. _ EPF.jj1:T FF_ FS: $ � No. of Recessed Luminaires No. of Ceil.-Susp, (Paddle) Fans INo. of - Transformers KVA. No. of Luminaire Outlets No: of Hot Tubs above In- _ IGenerators KVA 'o. o Emergency Lighting --� No. of Luminaires Swimming Pool ❑ ❑ _ ?rnd. rnd. Battery Units No. of Receptacle Outlets INo. of Oil Burners FIRE ALARMS No. of Zones No. of Switches _—]rro. of Gas Burners No. of Detection and No. of Ranges � I' _ No. Air Cond. -total Initiatin Devices _ of i Tons No. of Alerting Devices 1 No. of Waste Disposers _ Heat E um Number Tons KW ..r ................................................. Totals: _ No, of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW _ Local [] Municipal ❑Other n No. of Dryers Heating Appliances KW S rity Svstems:x or E uivalent No. of Water No. of No. of Heaters K� Signs Ballasts Data Wirin g' No. of Devices or E uivalen, Y_ No. Hydromassage Bathtubs No. of Motors Total HP Felecommunications Wiring: No. of Devices or Equivalent _ OTHER: ' •- r TAttach additional detail if de�ir_,d, o• Ulic�:V:- Estimated Value of }lectrical Work: _ `t' _ (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C©/VERA, E: 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. CHECKONE: INSURANCE [Z BOND ❑ OTHER ❑ (Specify:) Self Insured I certify, under the pains and penalties ojperjury, that the int rmation on this application is true and complete. FIRM NAME: ADT Security Services LIC. NO.: C Licensee: Mark A. Brophy _ Signature LIC. NO.: C-45 _ (If applicable, enter "exempt " in the license number line) Bus. Tei. No.: 603-_E,94-5928 Address: 18 Clinton Drive 'rollis, NH Alt. Tel. N'o.:__. _ *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 00953 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature _ Telephone ;No. _ EPF.jj1:T FF_ FS: $ � o- EEZL tibE (888) :831N30 JIVO 3:IVS OI(] �auolssl-w�wyo�� / Z 0 dW 'OOOMaON 1S 3S2i0W l I I 301��{3S y N aS 1Hd02i9 d NbF/W S 1©b :asua�l�-S O'L8l :ou �l 600 i 0/ZO : saildx3 ES6000 00 SS :� wnN - 3SN3011- S A13jyS 0119f1d 301N3W1aVd30 �cauauco' ��� . v -- suogeIOPad IIV 6uoIV 4oela4 ua41'ploj SUM Oi/i£/LO 0 Sh SUM 209h-Z90Z0 t/W QOOMaON 1S 3SaOW iii 0- 8S AHdOag V Navw 'ONI `S3bIAa3S 11Ian33S 1Qd 3dAi 01 3SN3011 SIHl S3(1SS1 HOLO HIN00 W31SAS a32131S103H b3 SNVIOIN10313 30 ... aadOU , S113SfIHOVSSVW 30 H13t13MNOWW00 1 suolleIo a P d Iltl 6uoly yaela(] uayl -ploj o- EEZL tibE (888) :831N30 JIVO 3:IVS OI(] �auolssl-w�wyo�� / Z 0 dW 'OOOMaON 1S 3S2i0W l I I 301��{3S y N aS 1Hd02i9 d NbF/W S 1©b :asua�l�-S O'L8l :ou �l 600 i 0/ZO : saildx3 ES6000 00 SS :� wnN - 3SN3011- S A13jyS 0119f1d 301N3W1aVd30 �cauauco' ��� . v Date ..,%�v"'. 5 ........ NORTH pf o ,°1tip I � 3� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..t.;fn r. � ...13 4r. k..1 ���.................. has permission for gas installation ................. in the buildings of,. % I/ ��!' �w� ..�rS'/�!?t (............. atorth Andover, Mass. Fee. .5. ... Lic. No: �.... ... .... • � ..... GA INSPECTOR Check # 7Uu'j MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date Cly 6�. Z001 NORTH ANDOVER, MASSACHUSETTS Building Locations ! do 6d1&*4Z1 fJ a, Permit # 700 Amount $ SS_ — Owner's Name &961_RRA New ❑ Renovation ❑ Replacement Plans Submitted (Print or type) Name of Licensed Plumber or Gas Fitter 99CW ALAMA-ZrA, Check one: Certifica e� Installing Company Corp. �U Partner. © Firm/Co. INSURANCE COVERAGE Chec on . I have a current liability Insurance policy or it's substantial equivalent. Yes I No ❑ If you have checked yes, please ' icate the type coverage by checking the appropriate bo . 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 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 1 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 Massas State G s Code and Qhaptpr 142 of the General Laws. awn :OVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 9!;4 Gas Fitter License Number Master Journeyman x rrA w a o x H a o UD H z ] c z F w d x z F W O U a z w F fix„ Z H a C� > z w o H z UG o N W x x O x w 3 A CQ7 B U a > SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR IN 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) Name of Licensed Plumber or Gas Fitter 99CW ALAMA-ZrA, Check one: Certifica e� Installing Company Corp. �U Partner. © Firm/Co. INSURANCE COVERAGE Chec on . I have a current liability Insurance policy or it's substantial equivalent. Yes I No ❑ If you have checked yes, please ' icate the type coverage by checking the appropriate bo . 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 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 1 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 Massas State G s Code and Qhaptpr 142 of the General Laws. awn :OVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 9!;4 Gas Fitter License Number Master Journeyman The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA -02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): W� Address: Po 9yy : % Z5 - City/State/Zip: hkg lei Idg • Q 1E Phone #: 970 lgt.5+ 2ol c) Are ou an employer? Check the appropriate bog: W 1. I am a employer with L 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ❑ I am a sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub -contractors have working for in any capacity. workers' comp. insurance. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.1 1-Dlectrical repairs or additions I L KPlumbing repairs or additions 1 .❑ Roof repairs 13.❑ Other `..;.y app::c t ih� ; �eci:s �cx �1 mum ;.Is; .11 out the section below showing their workers' compensation policy infrnmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: Job Site Address: Expiration Date: 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 cenp under the pains and penalties of perjury that the information provided above is true and correct Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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 including the legal representatives of.a deceased employer, of the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartrnents 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 members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit.. The affidavit should be re uri ned 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 Iicense or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. 600 Washington Street Boston, MA. 021.11 Tel. # 617-7274900 ext 406 or 1-8.77-MAS.SA.FE Revised 5-26-05 Fax # 617-72.7-7749 www.mass.govfdia Date. c! 1. /7'. 19 TOWN OF NORTH ANDOVER ERMIT FOR PLUMBING s � r CH • o++ '' a �►,� °++no •Aly i This certifies that .. ...........................r .......... has permission to perform ..T>ls `'' �r �i�s..— .............................. plumbing in the buildings of .............. ........... .... . at ��U...C. ��.� ` �` ,7. �.. . - ... , North Andover, Mass. e Fee ....Lic. No..Q .5. .............................. 21cj � PLUMBING INSPECTOR Check .N U/ 8 '1 0 It, So FIXTURES Date. ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �a This certifies that . ...... , v % has permission for gas installation ..'Q ... �r� '�v...... . in the buildings of .. f h/ti,!'A.. F !'.................... . at . �Uv ..�'�?����� r...r .' ...... , North Andover, Mass, Fee.qQ � 5 5 - ,IIE GAS INSPECTOR Check # 21 �i� 6827 '// '/ �' 'q 'q Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.`:`'`. . ....................... has permission to perform ....... wiring in the building of ................ ......... za-I ............................................. ........... at .... ........... .. �� ....,North Andover, Mass. Fe/ .......... Lic. No..��J: ... ............... . .... .............. . V Check # , * ilICTRICAL INSPE ffl E4 j'/- 'a' Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that............. R�,�.................L og�.v..... ....................................... has permission to perform ...... .`.L7......... zwp.-�a7 . ...... ,- wiring in the building of ...... 4, *� ...... at ..................... .... 9t) ................ . North Andover, Mass. Fee Lic. No. ?�-� V.4..........!. . .... 4.�'td .... .. �. Check # ELECTRICAL INSPECTOR 61 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. n!:�&Z Occupancy and Fee Checked Rev.1/07j (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (M EC),.527 CM 12.00 (PLEASE PRI NT I N I NK OR TYPE ALL I NFORMATI ON) Date:6 City or Town of: NORTH ANDOVER To the I nspedor of res: By this applic ation the undersigned gives notice of his or er intention to perfo t electrical workibed below. Location (Street &Number) 700�'i%cO`1✓I C_ _ w _ _itRoyni��'H Owner or Tenant Owner's Address No. of Ceil.-Susp. (Paddle) Fanso. Isthis per mit in conj unction with a building permit? Purposeof Building No. of Hot Tubs Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity No. of Oil Burners L ion and Natureof Proposed Electrical Work: 5%%P1'ULkyICl9 SiPrn,%r)wrtC��.0 SOc No. 478-4P3 -/300 Xloc Yes ❑ No (Check Appropriate Box) Utility uthorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters y �~AzC t CA/0,^fCe--, C JC!`ew t lam• A0 lb -' Comp) eti on of the fol I owi ng tabl a maybe waived by the Inspector of 1M res. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fanso. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool ove ❑ n- El rnd. rnd. mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners o. ion an I nitiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals ., um .er ons ......... o. - on aim Detect ion/Al ert i n_qDevices No. of Dishwashers Space/Area Heating KW Local [:1 uniapa E] Other No. of Dryers Heating Appliances KW becuritNo. of evici�or Equivalent No. of Water KW o. o. Signs ns Ballasts Data Wiring: No. of Devicesor Equivalent No. Hydromassage Bathtubs No. of Motors Total HP ecommurn cations 0ring: No. of Devicesor Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of V1ilres. Estimated Val ueof PIectr cal Work:�Xo .100 (When required by municipal policy.) Work to Start: //,PO Inspectionsto be requested in accordancewith MEC Rule 10, and upon completion. I NSU RANCE OV RAGE: 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 certifiesthat such coverage is in force, and has exhibited proof of sameto the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the insand penalties of jury, that the information on thisapplication istrueand complete. FIRM NAM E:17.v/ Flhoti is/P !'! C. it LIC. N0.:.tl/$/.� Licensee: "MVI 19h Vm Signature LIC. NO.:6-jo1%6-/ (If applicable, enter "exempt 'n t lice mb l' e.) // Bus. Tel. No.:4-�3 V?-? ;z Addressc+�nu� Alt. Tel. No.: - G "Per M.G.L c. 147, s. 57-61, security work requires Department of Ri6llic Safety "S' License: Lic. No. OWNER'S INSURANCE WAIVER: Ian aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 7,90 1 2 -D21? �, �14- I s The Commonwealth of Massachusetts �. De artment o P f Industrial Accidents ►' Office of Investigations `; , 600 ff"ashington Street Boston, MA 02111 4' • w►vw-mass-gov/dca Workers' Compensation Insurance .c}avit: guilders/Contractors/Eleetricians/PIumbers Dolicant Infinrmatinn Name (Business/Organization/Individual Address: City/State/Zip: Phone #: al:3 P Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10,021 ectri Cal repairs or additions l l .❑ Plumbing repairs or additions 12.❑ Roof repairs 1.3.❑ Other Homeowners who submtt•ihrs atiidevit indicatirli, Gley alt loin • r? work compensation policy mtormation. }� e:d fiat hire outside eoniriu;iors muni submit a new affidavit indicating such, tContractors Thai check this box must attached an additional sheet showing tile, name of the 9115-con—uaetors and their workers' comp, policy information. tam an employer that is providing workers' compensation insurance or � e to ees. Below is the oft andjob site information f Y P c1' I Insurance Company Policy # or Self -.ins. Lic. #: Expiration Date: .lob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). .Failure to secure coverage as 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 certt5xWnder the pai¢ndpmt/elf perjury that the information provided above `ts true jind correct 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 Are you an employer? Check the appropriate box: v 1. ❑ I an a employer with 4. ❑ I am a general contractor mployees (full and/or part-time).* and I have hired the subcontractors 2)�J am a sole proprietor or partner- listed on the attached sheet $ ship and have no employees These subcontractors have working for me in any capacity. workers' comp. insurance. [No workers' comp, insurance 5. El We are a corporation and its required.] 3. ❑ I an a homeowner doing all work officers have exercised. their right of exemption MGL myself. [No. workers' comp. per c. 152, § 1. (4), and we have no insurance required.] t employees. [No workers' COMP. insurance required.] +Any applicant that checks box # i .must also fill out the section below showing their workers' P Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10,021 ectri Cal repairs or additions l l .❑ Plumbing repairs or additions 12.❑ Roof repairs 1.3.❑ Other Homeowners who submtt•ihrs atiidevit indicatirli, Gley alt loin • r? work compensation policy mtormation. }� e:d fiat hire outside eoniriu;iors muni submit a new affidavit indicating such, tContractors Thai check this box must attached an additional sheet showing tile, name of the 9115-con—uaetors and their workers' comp, policy information. tam an employer that is providing workers' compensation insurance or � e to ees. Below is the oft andjob site information f Y P c1' I Insurance Company Policy # or Self -.ins. Lic. #: Expiration Date: .lob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). .Failure to secure coverage as 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 certt5xWnder the pai¢ndpmt/elf perjury that the information provided above `ts true jind correct 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 Information a.nd Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined. as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as `pan individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and inciudiri.g the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit,to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit compi-etely, 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 members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may 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 re<_m-ording the -lam, or if you are required to obtain a workers' compensation policy, please call the Department at the numnber:iisted below. Self insu,cd 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/iicense number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year, need. only submit one affidavit indicating current policy infonnation (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 burnleaves etc.) said person is NOT required to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The 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 -MASSA -FE Revised 5-26=05 Fax # 617-727-7749 mass.govidia I -N Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use On75��, Permit No. Occupancy and Fee Checked [Rev. '1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)_ %Q I C zv Roan /y/✓/.�yc2 M,� Owner or Tenant A S 4 L A N 6 rA 2M S Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und d b'r' ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: u""&&Juaat aetaa y aestrea, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME'. IVcvJ 2 N T LIC. NO.: Licensee: Signature LIC. NO.: (If applicable, enter "exempt " in the license number line) Bus. TeL No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" Lie e: Alt Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner Owner/Ag❑owner's agent e Signature Telephone No. PERMIT FEE: $� The Commonwealth of Massachusetts k� ! Department of Industrial Accidents Office of Investigations °r=t'600 Washington Street a Boston, MA 02111 www.moss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organiza6on/Individual): Address: of\1.r City/,State/Zigq U N u 63 6 0phone #:. Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).' 2. ❑dam .a.sole proprietor or partner. have hived the sub -contractors listed on the attached sheet I 6. ❑ New construction 7• ❑ Remodeling ship and have no employees These sub -contractors have . S. Q Demolition working for me .in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its g ❑Building addition required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 10. E7 Electrical repairs or additions 11.❑ Plumbing repairs or additions myself. [Nomorkers' comp. c. 152, § 1(4),'and we have no 12.[] Roof repairs insurance required.] t .employees. [No workers' 13.❑ comp. insurance required.] .Other —1r cppiu: M mar enecxs box n t must also fill out the section below showing their workers' compensation policy information, nformationt Homeowner; who submit this affidavit indicating they ars doing all work and then hire outside conuactors must submit a new affidavit indicating such. ;Contractors that check this box mustattaehed an additional sheatshowing the name of the sub -contractors and their works' comp. polies, ininnnation. 1 am an employer thw is providing:workers' compensation insurance for my employees: Below is. the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/stat 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 $4500:00 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 ofll e DIA for instl{anbp coyefffte verification. I do hereby ce.06 under that the information provided Date: l� 0. (ficial use only. Do not write in this area, to be completed by city or town official is tw and correct City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: t., 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 including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 'However the owner•of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence,of compliance with the insurance'coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation. affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-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 members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurarnce'license number on the appropriateline. 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/iicense 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 Investigations 600 Washington Street Boston, MA 42111 Tel. # 617-7274940 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-77451 www.mass.gov/dia Date ... !D:..".. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.. !.................................................... ........................ .............. has permission to perform 1--W mea z- ���17 S k 17-eVC v .................................................................. wiring in the building of .... /,51 S �L.��/� �qi�,�.a,S............................. ................................. at .. 0..... , North Andover, Mass. FeeA� I. 07'7:.. Lic. No....L1OGZ/.q.............,, ... ELECTRICAL INSPECTOR Check # _� _�_b 6�t1 1 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 1W BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 10/27/08 Job # 2002 City or Town of NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 700 CHICKERING RD Owner or Tenant ASHLAND FARMS PAT Owner's Address Telephone No 978-376-1430 Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Undgrd ❑ New Service Amps Volts Overhead ❑ Undgrd Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: WIRE TWO FAN COIL UNITS IN KITCHEN No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool d. Above ❑ In- rnd. ❑o. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Snitches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers eat Pump . Totals: umber ................................................................... ons o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW ecuritv of*,stems: No. 'Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications irmg: No. of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) 11/01/08 (Expiration date) Estimated Value of Electrical Work: S (When required by municipal policy.) Work to Start Immediately Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: Mercier Electric Co. NO.: A-11062 Licensee: Richard W.Mercier Signaiur J J114 g, g I NO.: A-11062 (If applicable, enter "exempt" in the license mmnbei line.) Bus. Te No--' 508-792-9200 Address: 139 Southbridge St.,Auburn.Ma.01501 P.O.Box 357 Alt. Tel. No.: 508-864-2839 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. 125.00 Signature Telephone No. r., 3 �� oL 61 * ti BUILDING DEPARTMENT Community Development Division December 5, 2008 Julie Luther Information Specialist Planning & Zoning Resource Corporation 100 N.E. 5' Street Oklahoma. City, Oklahoma. 73104 Re: Ashland Farms (Ref# 48645-4) 700 Chickering Road (Massachusetts State Route 125) 1. The current zoning classification for Ashland Farms (Map 83 Parcel 1) is Residential —5 (R-5). 2. North = Residential — 4 (orange) South = General Business (purple -red) East = Residential — 2 (yellow) West = Residential — 5 (brown) Zoning Districts Bushes* 1 CDD- ® Industria S i Residentia' 4 Bushess 2 ® General Business - PCP r 5 Residentia^ 5 Bushess 3 0 hducIrW ; Q Residential 1 Residenda, 6 ® Bushess 4 IndustvWl 2 Q Residential 2 Q Vdnape Commercia' Q COW ® IndusW 3 Q Residential3 Q Wage Residential Ocerla-i' Districts Watershed I'mtedisn Distnd Hictor.cDisMct ✓'<du'.1 Overlay District Cater Resources Lakesd?onds - RNarStreams wetland Resource Kaes Page I of 4 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9545 Fax 978.688.9542 Web www.townofnorthandover.com BUILDING DEPARTMENT Community Development Division Figure 1 Zoning districts surrounding Ashland Farms, 700 Chickering Road 3. Ashland Farms is not a Planned Unit Development. 4. There are no overlay or restrictive districts that apply to Ashland Farms. 5. Section 4, Paragraphs 4.124.16 (Residential 5's Buildings and Uses Permitted) of the North Andover Zoning Bylaw states: "Nursing or convalescent home -see dimensional requirements of Table 2 (Special Permit required).", so Ashland Farms is an allowed use by its Planning Board Site Plan Special Permit dated February 28, 1994 and recorded in the Essex North Registry of Deeds at Book 4131 Page 164-179. 6. The property parking conforms per the Zoning Board of Appeals Variance decision #001-94 and recorded in the Essex North Registry of Deeds at Book 4178 Page 220-2. 7. Please find attached the Zoning Board of Appeals variance decision 001-94 and the Planning Board decision dated February 28, 1994. 8. There do NOT appear to be any outstanding/open zoning or building code violations that apply to 700 Chickering Road except that the fee for the yearly Certificate of Inspection has not been received. 9. An approved site plan for the subject property is on file, but our office does not have the necessary resources to reproduce and distribute copies of the plan. Planning Board decision dated February 28, 1994 is attached. Page 2 of 4 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9545 Fax 978.688.9542 Web www.townofnorthandover.com a',�T..�° �6*•rye\ o BUILDING DEPARTMENT Community Development Division 10. A valid Certificate of Occupancy has been issued and is now on file for Ashland Farms. The Zoning Bylaw is available through both the Planning and Zoning Board home pages in the Town's web site, www.townofnorthandover.com, Please find attached copies of the relevant Zoning Bylaw, Zoning Tables, Footnotes, Zoning Map, Assessor's Tax map 83, property card for parcel 1, Certificate of Occupancy, and Board decisions. Sincerely, Gerald A. Brown, In of Buildings/Zoning Enforcement Officer cc: file Page 3 of 4 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9545 Fox 978.688.9542 Web www.townofnorthandaver.com Q �T�.lD 164�NO 6 BUILDING DEPARTMENT Community Development Division Printing Town's website materials: 11-26-08 ca. 6 minutes Examining 700 Chickering Road files: 11-26-08 ca. 18 minutes The 1 -hour administrative fee includes organizing, photocopying, producing, and providing postage for the zoning analysis of Ashland Farms: 12-5-08 ca. 1 hour 84 minutes @ $100.00/hr. = $140.00 for researching Ashland Farms, 700 Chickering Road. Please write check to: and send to: Town of North Andover Town of North Andover Building Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 Page 4 of 4 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9545 Fax 978.688.9542 Web www.townofnorthandover.com Date.� ry ' .1 � .. . TOWN OF NORTH -ANDOVER PERMIT FOR PLUMBING This certifies that .. (�.� ..� /..f.: ! ............. . has permission to perform ..... .... . plumbing in the buildings of .. � �'}.� cJ, , , !� a!r t�!�S. , , , , , at .. ,... %�f�... !! `.� ( � • .... , North Andover, Mass. Fee. .(?P -6q . Lic. No.. �js .... .... /! . /` (.�-r........ . PLUMBING INSPECTOR Check # 7772 Date ..?/a Z/G. 5 ....... TOWN OF NORTH ANDOVER • -'� PERMIT FOR GAS INSTALLA ON 2 ,C`no r, ctS 14 This certifies that ... l,r� .��.t. { T. A. ...� .............. has permission for gas installation in the buildings of ............ at U D c <..�. h �. r, �............. . North Andover, Mass. Fee. .... Lic. No. �........`'? �� ..... . GASINSPECTOR Check # 2 3 1 7 f f+ r, -, Business T of :Ve2nse::- `�e-et �" s-"�A2 Licensed Plumber or Gas FrHer u n r Signature of Gasfiitter asier `. License Number SS°1�1 Journeyman ` Date./ J o'<V40 �T :1+ TOWN OF NORTH ANDOVER PERMIT FOR PLUMONG D••TID �``'� ,SSACMUS� This certifies that ...`��...� .r� ... ,� ?t S.......... . L has permission to perform ... ........................... plumbing in the buildings of ...... ....... North Andover, Mass. Fee,?r ..... Lic. No..k.!"5. ?. ........ .:1.�..,.,,�'�, ..... . PLUMBING INSPECTOR Check # 7 614 p. �: W 1•W . y.lm 0 .�.. V S O . z C S W <. y. 0 W to C .0 96: < C :.40 "q - J ..Z. C Q o. �. ..� G c: 1st .'� ..2 S. Y d Q K ut Y : W . x J. m a a aU. a �.Q < -J1 s.;._� <' o �.. SUR -B'S -MT. BASEMiHT ' IST FLOOR IND FLOOR S R D FL OOR ` 4TH FLOORAL STH FLOOR 6TH FLOOR.,. . 7TH FLOOR 8TH FLOOR .JI , one Certificate installing Company Nam - Corporation Address , 10 Q , MO )]. Partneratip Q # O Fimr1'Co:. Business Telephone,; Mame of Ucensed Plumber L INSURANCE COVERAGE: . which meets the requirements of MG! Ch 142. i have a current 1'�abir>tiy insurance paicy or its substantial equivalent Yes. C No 0 if you have checked Yes. please indicate the type coverage by cheddngthe°.apprgpriate box Aliabil insurance policy Other type of lnderruft;:D Bond INSURANCE WAIVER:. i .am,aware ;that the -licensee does got have the insurance coverage.required by' OIKt+iER'S General !aws;..and that my..signature on thls permit app�igtion .waives this requirerfientw Chapter 142 :of the Mass: Check, pne. Owner U4genf ❑ Date. TOWN OF NORTH ANDOVER . i PERMIT FOR GAS INSTALLATION p9 This certifies that ... ;� .. .�a.... ! t.f:. ........ ^� has permission for gas installation .... I ... ���� .. . in the buildings of ....4 . F/ . `... ' at .. �.� G ... c �. !�.. L !�. �.. , North Andover, Mass. FeELic. No..7 ?.�. ........0 GAS INSPECTOR Check # 6195 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) I / � _ r/ s�elou' r Mass. Date_ /8 Permit# S' d) Building Location_ 700 (Aek' n i;I9 12d 'Owner's Name S �l1c;i1Ci~ /'"c� oo1 SSlS'T�°ct� �/ Ii /i'19 Type of Occupancy G New ❑ Renovation ❑ Replacement j4 Plans Submitted: Yes❑ No Installing Company Name F. A. WILLIAMS, INC . Check one: Certificate Address BOX_ 148, 12 BRIGHTON STREET X$ Corporation 1934-C BELMONT, MA 02478 ❑ Partnership Business Telephone 617-489-4770 ❑ Firm/Co. Name of Ucensed Plumber or Gas Fitter V z a n c i s A Williams INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked yes, please Indicate the type 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 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 luwwledge and that all plumbing work and installations performed under the permit I&Ved for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the ral Laws. BY TyDe of ucense: Plumber gnature or ucunsedum r or Gas Fater Title Gasfilter 7258 "— Master License Number Qty/'Town Journeyman APPfiOVED I ■rrrlrrrrrrrrrr■ ■rrrlrrrrr■ ■rrrrrrrrrrrrrrrrrrrrrrrr■ ... ■rrr�rrrrrrrrrrrrrrrrr�rrr■ ... ■rrrrrrrrrrrrrrrrrrrrrrrr■ .' ... rrrrrrrrrrrrrrrrrrr�rrrrr■ ... ■rrrrrrrrrrrtrrrrrrrrrrrrr■ ... ■rrrrrrrrrrrrrrrrrrrr■ ■r■ ■rrrrrrrrrrrrrrrrrrrr■ ■r■ ... ■rrrrrrrrrrrrrrrrrrrrrrrrr ... rrrrrrrrrrrrrrrrrrrrrrrrrr Installing Company Name F. A. WILLIAMS, INC . Check one: Certificate Address BOX_ 148, 12 BRIGHTON STREET X$ Corporation 1934-C BELMONT, MA 02478 ❑ Partnership Business Telephone 617-489-4770 ❑ Firm/Co. Name of Ucensed Plumber or Gas Fitter V z a n c i s A Williams INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked yes, please Indicate the type 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 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 luwwledge and that all plumbing work and installations performed under the permit I&Ved for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the ral Laws. BY TyDe of ucense: Plumber gnature or ucunsedum r or Gas Fater Title Gasfilter 7258 "— Master License Number Qty/'Town Journeyman APPfiOVED I Date. /00 TOWN OF NORTH ANDOVE PERMIT FOR PLUMN This certifies that .. , ................ has permission to perform ... H. s -A, ................. plumbing in the buildings of at ...7.G P.. cl'� '� `1` `�� , North Andover, Mass. Fee. h L.... Lic. No.. .. ...........,....'U. PL MBING INSPECTOR Check # ! Z r j- t- 7 7IS4,0 NORTOI O 9 SA US Date. /00 TOWN OF NORTH ANDOVE PERMIT FOR PLUMN This certifies that .. , ................ has permission to perform ... H. s -A, ................. plumbing in the buildings of at ...7.G P.. cl'� '� `1` `�� , North Andover, Mass. Fee. h L.... Lic. No.. .. ...........,....'U. PL MBING INSPECTOR Check # ! Z r j- t- 7 7IS4,0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING . (Print or Type) 0 Mass. Date. /0- 9 -- Permit # �~ d Building Location _ZQ0 C'11 I C X P r/' a 24 Owner's Name ASS, lmonl I�a•�rrr AscvST ed z/ U 14 4 Type of Occupancy New ❑ Renovation Replacement �d Plans Submitted: Yes ❑ No FIXTURES Installing Company Name F. A. WILLIAMS, INC . Check one: Certificate AddressBOX 148, 12 BRIGHTON STREET ® Corporation 1934—C - R F r M Q N T• M A 02478 ❑ Partnership Business Telephone 617 — 4 8 9— 4 7 7 0 ❑ Platt/Co. Name of Licensed Plumber _ Francis A. Williams INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ if you have checked ves. 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 permit application waives this requirement. Check one: 5anatura nr ('lwncr n. Owner ❑ Agent ❑ i nereoy cerury 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 rformed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbi Code and Chapter 142 of ttA Genpraj Laws. t3y • Title gnature of Ucense Plumber Type of License: Master ® Journeyman 3a41n, City/Town ❑-��' 7 2 5 8 OF IC ONLY) License Number • r • Y • son do NOON NOON NOON Installing Company Name F. A. WILLIAMS, INC . Check one: Certificate AddressBOX 148, 12 BRIGHTON STREET ® Corporation 1934—C - R F r M Q N T• M A 02478 ❑ Partnership Business Telephone 617 — 4 8 9— 4 7 7 0 ❑ Platt/Co. Name of Licensed Plumber _ Francis A. Williams INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ if you have checked ves. 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 permit application waives this requirement. Check one: 5anatura nr ('lwncr n. Owner ❑ Agent ❑ i nereoy cerury 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 rformed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbi Code and Chapter 142 of ttA Genpraj Laws. t3y • Title gnature of Ucense Plumber Type of License: Master ® Journeyman 3a41n, City/Town ❑-��' 7 2 5 8 OF IC ONLY) License Number k Date .....'57 ;7JA=-e-7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... 7A-4 . ..... ... S. ............ has permission to perform ...mac.. o- . ... ............ S W4 r4 wiring in the building of ... -;Wsn -f ............ Fk,!d7 at ....... 7 North Andover, Mass. 10 Fee...S...... S.s Lic. No .............. ...0.. ......... ......... -�V 9 ELECTRICAL IN SPECMR Check # 7 Z Commonwealth of Massachusetts t Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS it, Official Use Only Permit No. 7 Z 2?16 Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod�/5 MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -5Q City or Town of. NORTH ANDOVER To the In pect r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) ' r t �-4R5h1flohq rY✓1 Owner or Tenant �My�r � Telephone No. 9-ilg-. O' 13-00 Owner's Address Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building fe:V%r ; 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: eeno ut44)r -00,rn Completion of the following table may be waived by the Inspector of Wires. No. of Recessed LuminairesNo. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ o. of Emergency Lignting rnd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW ....... No. of elf- ontained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Elec rical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VE AGE: 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 5Q BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: A940 >e Licensee: �i�tltt `t 141 � V'a q11) Signature LIC. NO.: (If applicable, enter.exempt" in the license number line.) Bus. Tel. No.: 13 aP Address: 19 QjAqddc,�r-:ijvn-nips-04 Q -t Alt. Tel. No.: &0 - 9,13- 19,3 ( *Per M.G.L c. 147, s. 57-61, security me work requires Departnt of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: Mj The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 '� "s4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information(� ((�� Please Print Legibly Name (Business/Organization/Individual): ACIarR,J Akamkil4V'la, Address: %q Qu4a;CL 4zvn 76-VIn e—C City/State/Zip: 77 Phone #:160 -913- 72,31 Are you an employer? Check the appropriate box: . ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. g I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. I These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. [ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *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: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as 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 cegW under the pAns and penalties of perjury that the information provided above is true and correct. Phone #: ,SOg _ 80 J 1302 0 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 #: e -17 Date. .14/_. ... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..... ........................... ........... has permission to perform-... . plumbing in the bui dings of .................... ............. at .... ......... ..... .. ';'1 ........ North Andover, Mass. Fee. ... Lic. No.e�� . ........... PLUMBING!INSPECTOR Check # 7 3 U0 6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS A / I I r - Building �),�o Date Permit #_2&f _�el' Amount Pd Type of Occupancy New Renovation Replacement [] Plans Submitted Yes No FIXTURES `a Print type) Check one: ® Corp. Certificate Installing g Compan Name � Address ��` �^� Partner. Business Telephone T 7 7 11 Firm/Co. Name ofLicensed Plumber. Insurance COyerane: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 13 Other type of indemnity 1-3 Bond 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 lgnature 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 State Plumb' e an Chapter 142 of the General Laws. 1Title ;D (OFFICE USE ONLY Type of PluTbing License License Number Master Journeyman El Date......f�.'_. . TOWN OF NORTH eTALLLATION OVER PERMIT FOR GAS 1 This certifies that ... �... ...... `. *. '.:........... . has permission for gas installation.;<�::tie?o: ---"'............ in the buildings of.,. -r!..'` `."".. ....... . at ... �. ... ....`:J!`"`��-�`~"'`^j '� f North Andover, Mass. Fee. ...... Lic. No.......!� _�. ' .......... I GAS IIfS &O* R. Check # 5.91 uewXiwnof lalselN joQwnm asuaai J04H seD (,3ogwnld El aau!"seD J �aq nld pasuool l jo amleugiS (AlNo 3sn 331330) a3AO2lddd umoi/4!D al1!.L sMe� leJauaD 041 JO Zb l JaldegD p% apoD 6D ale1S sllsuasnya¢ssulN ayl JO suo!s!nad luou!uad Ile yl!M aouelldwoo u! aq II!M uollea!Idde s!yl joj panssl l!uuad japun powlojjad suo!lellelsu! pd0 �1aoM Su!gwnld Ile 1ey1 pus aspalMou�l AWj' o lsaq 13 ayl of alemoo0 pue anal amuo!30o!ldde anoge u! (paialua jo) pau!wgns ansy l uo!lsuuo3w pus SPEWaylJo 1101ey1 4j!uao �(gajay luasd u iauMO luasd s,jauMO Jo JouMp jo ainl0us!S :auo �loagD luawai}nbaa sryi san!eM uopeolldde 3!uu2d slyl uo ainpuS!s Aw 1ey1 pu0'sMe'l IvJ2uaD 'ssulN 241JO Zbl JaldeyJ Xq pannbai aSUJ2no3 2owinsul 241 angy lou saop 22SU2311 ayl leyl aJEMe we l Jan!eM aouemsul s,jauMO Elpuo8 [3 4!uwapu! 3o ad,l layl0 �(o!lod aou0msu! �fl!1!g0!-i oq ale!ldadde ay18u!�laaya Aq 2BU�anoa adf4 ayl aleolpu! assald `sax pa�loaya ansy noXjl ❑°N sa,� •1ua10n!nba 10lluelsgns s,l! jo Aollod :auo �loagD aouemsul ,tl!l!g0!l luaamo a an0y i 3DVN3AOD 33NVIIf1SNI MIA SED Jo lagwnld pas0311JO awsN 0 auo da a ssouisn '12uu0d C ssaippv �•dioD ,fusdwoD su!pols' al o►g!uaD :auo (adf4 io luud) lunowd # 1!uuad Hoop "HIS Ho0'ld H I i Hoo1A 'HII HOO'id 'HIS HOO'13 H10 Hoo33 a H f H007d a N z HOO'13 *.LSI .LN3 W3sV8 3 W3sve-8nS pau!wgnS susid luawaoeldo-d 'Eluo!30n000-d11 MON mm� aweN s,Jaun►p suollsoo-1 Su!ppl] C210(1 v `" S,L1.3SflHJVSSVW `N3AOQNV H1,aON p 4 / (luud jo adAl) OAII.L1.i,3 Sd9 OQ QL JAAMd HW No LVjnddd MoLi Nf l SInSfWdSSM 1 -da Io p m.0 p ca 2 W Y i h$V c o m ti 4 v CO o 0) mW oW UIt maU 720 a CD m Q 1-0) °Da W cp x OD M O as mmmv O V o CL= L m o a` 2L: Eo mmmmW coco5�L ommmmU U0 J N MO O C21 HccoA O U mQ m m c 9,0 co � 1t0 r a0 0 CL J S 00 E E ex 0 Z a Cl O J O O O W OG > W Acc d v� Z Q' epi Z Z a 000 W W N i� ~ WW �� Z V WO 4. = z 160 J W V W a (D Q 12 WC�QC4 a MQ N 0 W CL i rn m 0 4 4 0 co 0 0 N a � o rn a Ci v� ^G) V r m MQ N 7 OLO Ni i ` - Town of North Andover �� OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978)688-9531 June 15, 1999 EMG Thomas 0. Bailey, R.A. Program Manager 11011 McCormick Road Baltimore, Maryland 21031 Re: 700 Chickering Road EMG Project No: 57567 Dear Mr. Bailey: A Fax(978)688-9542 Enclosed please find the information requested for Heritage at North Andover 700 Chickering Road North Andover, MA and a copy of the Certificate of Occupancy Permit issued at August 15, 1995. If you have any further questions please call me at 978-688-9545. Very truly yours, I D. Robert Nicetta, Building Commissioner DRN:jm File: 700 Chickering Rd The Heritage BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 It SS 03:Cep CNG CSQ$7 223-44GS p."2 F t To: Tovvu of North Andover Code Departtnent North Andover, RIA 01845 Department Tel: (978) 688-'.0545 / FAX; : (97S) 688_1)556 t2- r-)c.T- !"' CcT( n Re: Heritage Ott "Sorth Andover M() Chk:hNrhl- Road No_,-th Andover. NIA 01845 ETNSG Project No: 51-1567 Project Nfanaaer; Jobn K Ryan, RA - Dear 1,1. w(('(;uiltt: EMG is an en-iueering f rm currently conducting a property condition suite ev of the above referenced property. As part of the, due -diligence process we request your assistance by providing us with some information front your faes. Throi2ub 1be Freedom of Information Act, we request }'our assistance Uy pro-, id'mg us vvitb the following information concerning the site and buildings at the re ereaced propert}-: ■ What is the current property zoning? is it in compliance with all current zoning requirements`:' ■ Are there current_ tmresoh,ed lrOild.i(1i0 or zomug code violations at the property, and if so. c= copies of the inspection reports/citations be provided? NO ■ [s the property regularly in:51)ected by your department and if so, when was the rrm�sr recent inspection'? `��`� — t CZt—cZvtizcl� �� w►rr. sTi�2 r3`nQ , Zo,D� . ■ Does a Certificate of Occupancy exist for the property, and if so, could a copy be provided? yet — 6- (- j e -" .s Tlian-k you for your assistance in this matter. If you need additional information to complete our request, please contact me at (800) 733-0660. Responses may be faxed directly to our office at (410) 785-6220. Or ivailed to or corporate offices: EMG J Attn: 'Rotas O. Bailev, R.A. 11011 McCormick Road Baltimore, Maryland 2103I Please note the EMG file number and the Project Mmager's name on all corresporudeuce. Sincerely. FNIG Hionias 0. Bailey. R.A. RECEIVED Program Supervisor JUN 14 1999 da 9 I � 1; s . ?2` ,,,,; l t BUILDING DEPT. -n' 06/11/99 15:21 TX/RX N0.5544 P.002 ' �� I r 'CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 446 (1994) Date August 18, 1995 THIS CERTIFIES THAT THE BUILDING LOCATED ON 700 CHICKERING ROAD - "THE HERITAGE" MAY BE OCCUPIED AS MULTI -FAMILY HOUSING FOR SENIORSIN ACCORDANCE (100 UNITS) WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. SEE REVERSE SIDE FOR OCCUPANCY LOAD. „a R,,, CERTIFICATE ISSUED TO N.A. Assisted Living Ltd. C� 11 ... o'• C.0 ADS Senior Housding . ADDRESS 139 Main St., Cambridge, MA a ,=3ACMUSf G..... Building Inspector dun 11 SS 03:08p EMG iSGSi 023-4465 p.1 f r FAX COVER SHEET EIVIG INCORPORATED 110 11 McCormick Road Baltimore, Maryland 21031 FAX (410) 785-6220 TO: North Andover Code Enforcement Dept. Attention: Mr. Michael McGuire n� i FAX (978) 688-95.56 1 r' FROM: Thomas O. Bailey, R.A. I DATE: June 11, 1999 SER OF PAGES (including cover page) ..,3' 2 - NOTES: Please notify me if there are any questions regarding -In. this fax. 06/11/99 15:21 TX/RX N0.5544 P.001 ✓"�3�r� i I SS 03: GGp i ENG To: Town of North Andover Code E�erc _tri. tt DeV,!r?tiucnt North Andover, NIA 01845 ro7S) 6180-`)74` / FAX9: j9'7"1 6,U'^'56 9 Department Tei: , ., - - Attn Mr. Michael McCnt.ire Re: Heritage at -North Andover 700 t'likker�irr- Road North Andover, MA Cil X45 EMG Proiect No: 57567 Dear 4Y NIK'Gti::: (SGGf E23-4465 Project Manager: john{ K '+tar==, R_=! EMG is an engineerino firm current],- cartjuvring a property condition smvcy of the above referenced property. As part of the d«e-diligence process we request your assistance by providing us Niith some information from v"Our fides. Throagb ibe Freedom of information Act, we request y°our assistance by prodding us vrith the following information concerning the site and buildings at the referenced property: ■ What is the current property zoning? is it in compliance with all current zoning requirements? ■ Are there current_ irnresoh,ed cit' zo}t Mi code violations at the property, and if can copies of the inspection reports/citations be provided? ■ Is the property regttfarfy inspected by your department and if so, when tvas the awx ,St recent inspection? ■ Does a Certificate of Occupancy exist for the property, and if so, could a copy be provided? Thank you for your assistance in this matter. If you need additional information to complete our request, please contact me at (800) 733-0660. Responses may be faxed directly to our office at (410) 785-6220. Or mailed to or corporate offices: EMG Attn: "iltoraiis 0. Bailey, R.<a. 11011 McCormick Road Baltimore, Maryland 21.031 Please note the EMG fife number and the Project Manager's nacre on ail correspondence. Sincerely, EMG Hionias 0. Ba: ey Program Supervisor RECEIVED JUN 14 1999 BUILDING DEPT 41?�' l ' 1 LO, F -/"-x Fe are -TL, &�/��5 06/11/99 15:21 TX/RX N0.5544 P.002 P•2 Date (;1/1 .4-1 ...... p•4„to ,°.ry° 3? ` TOWN OF NORTH ANDOVER o PERMIT FOR GAS INSTALLATION This certifies that. w A .'.{ '..(? Q c. f'.' ...................... has permission for gas installation /.'. !........... in the buildings of .. .fe,� t:. .l� 1!x!1 j ............. at 7C.... t .1 . f 1 , North Andover, Mass. Cf�,,. Fee. .??.�. ... Lic. No. �?.�. ?... .. .. .......GAS � GAS INSPECTOR Check # 5!�. i; G MASSACHUSETTS UNIFORM APPLICATION FOR' PERMIT TO DO GASFITTING (Print or Type) Mass. Date 20 O(o Permit d Building Location ?�Q G�i1G�Z�t,121L1Cs, . AQ • owners Name _ Type of Occupancy j( 1 New Renovation ❑ Replaceen mt Pians Submitted: Yes ❑ No Installing Company Name l�k4 Check one: Certificate Address Pb av�L 72'8 Corporation 1608 - Mo AAAWyK ,AVv,4 d 1,9 Business Telephone 2]A t V2 ❑ Partnership Name of Licensed Plumber, or Gas Fitter cwt �- i✓�T� ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. ym No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVE : 1 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 isperml ilcation waives this requirement signature o Owner or Owner's Agent Check one: - Owner ❑ Agent ❑ I hereby certify that all of the details and Information 1 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GetAral Laws. Type of License: By r�6lumber Sign—a-tire of Licensed Plumber or as Fitter Title ❑ Gasfitter (;iryrTown aster License Number 27 APPROVED (OFFICE USE ONLY) eourneyman s • i e i • • • F401 15169161M MMM MM .. • �� MM MM .. ����■�����������MMM 66 VA1=9T9T.-ZjMMMMMMM mmmmmmmJ-41014 ���� mmmmm��Mmmmmm Installing Company Name l�k4 Check one: Certificate Address Pb av�L 72'8 Corporation 1608 - Mo AAAWyK ,AVv,4 d 1,9 Business Telephone 2]A t V2 ❑ Partnership Name of Licensed Plumber, or Gas Fitter cwt �- i✓�T� ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. ym No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVE : 1 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 isperml ilcation waives this requirement signature o Owner or Owner's Agent Check one: - Owner ❑ Agent ❑ I hereby certify that all of the details and Information 1 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GetAral Laws. Type of License: By r�6lumber Sign—a-tire of Licensed Plumber or as Fitter Title ❑ Gasfitter (;iryrTown aster License Number 27 APPROVED (OFFICE USE ONLY) eourneyman s Dat-CIA/l./e . . . . . . ... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING N&i�w This certifies that I/�, � /) ItIf (4 has permission to perform ....... ....... plumbin inyhe buildings of /�(: 1 (. l fj r �_/ 6 ........... at Z .Z/� i ............. North r, Mass. ...... Lic. No.,- ...... PLUMBING INSPECTOR 00 it Check # 5 � 3 4135.sl� MASSACHUSETTS UNOFORI M APPLICATION FOR PERMIT TO DO PLUMBING i (Print or Type) NoRTN A"DO "i , Mass. Dale Permit # f Building Location 200 catckfi'maA Owner's Name 4CU-CAC%E& Mo Aojlowj� Type of Occupancy 1?e-StOfr.IJ' j*L New ❑ Renovation ❑Replaces ent Plans Submitted: Yes ❑ No 1�0 FIXTURES S.P. # SELVI=R # SEPTIC # Business Telephone �18 2725- U- Z jj INSURANCE COVERAGE: I Check one: Xi,corporation ❑ Partnership ❑ Firm/Co. Certificate # I (vol I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. . Yes. X No ❑ If you. have checked yes, 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 permit application waives this requirement. Check one: Owner ❑ Agent O Signature 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 installation performed under the permit i3sued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. _-�►1 � ft Signature of Licensed Plumt:er Title Type of L:canse: Moatsr Journeyman I I Cityfrown License Nurttfser APPROVED (OFFICE USE ONLY) 1 1 • 1 • ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■■■■■■ M rig "ll. -Mm ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■■■■ Business Telephone �18 2725- U- Z jj INSURANCE COVERAGE: I Check one: Xi,corporation ❑ Partnership ❑ Firm/Co. Certificate # I (vol I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. . Yes. X No ❑ If you. have checked yes, 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 permit application waives this requirement. Check one: Owner ❑ Agent O Signature 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 installation performed under the permit i3sued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. _-�►1 � ft Signature of Licensed Plumt:er Title Type of L:canse: Moatsr Journeyman I I Cityfrown License Nurttfser APPROVED (OFFICE USE ONLY) Date./.. j/v . ........ pi io ,eye pL TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .�/......... � .._.... r...... ....,...�.:�-.,...._..-.. . i has permission for gas installation .. ,r.` . ; lin, • . ....... . in the buildings of . ,its Ul� ��_...�t!! .............. at . 7 Vii' ::�� 1(� f � 1 r'p .. , North r, Mass, Fee d' Lic. No.. �?. �/,/ i ....�.. c.... GAS INSPECTOR Check # 1 25►s0 �- t t Xi MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT. TdD, (Print or Type) Mass. Date —7 r' Fer Building Location Owner's .Name Type of OcCuparr New 0 Renovation 0 Replacement ;X Plans Su.bml '`"ga. co V) Cl) Ir W Z CO) cc ;Ati Cl) W a: W ?5 Qco co cc W F- 8 a: Go z 3: a: EX; 0 W W F- W cc 0 z 0 D CL cr 'E. W 0 Q W 0 Ul Z < X ir W U) cr W Z W U) cc W 0 F7- C) W x cc D Z Q ¢ Q LL 8 W j W� 0 —fir UCC > SUB-BSMT. 'BASEMENT -01101-14*14:. V AST.FLOOR 2ND FLOOR 040 41. 3RD:FLOOR .4TH FLOOR t 6TH FLOOR 8TH FLOOR. .7TH FLOOR 8TH FLOOR InstallingJ-CoMpany Name WHiTf--" PL fA Check one: ., Address',, �i 1) Knf- -72-A Corporati on 0 OJO 0 V (--YL VVI A - 0 L 8 0 Partnersh�lp 9,,, r, _. _ Business. Telephone _?7tq 1 0 Firm/Co. 'j. Name of. Licensed. Plumber or Gas Fitter 11) A CkA E= rC -INSURA NCEt.COVERAGE: I have a.current llabilityjnsurance policy or its substantial equivalent which meets the requilr' .*es'..' No 0 If you have.checked yes, please indicate the type coverage by checking the appropriate pirlate-boxel A liabllltyjnsurince policy. Other type of indemnity 0 Bond 0 OWNER'S' INSURANCE policy. I am aware that the licensee does not have the Insu rance , Chapter.,1.42'of,the Mass. General Laws, and that my signature on this permit applicationvA Check;'or Signature of Owner or Owner's Agent Owner 0 I hereby cert ' Ify that'all of the details and Information I have submitted (or entered) In above ap'plication'are true and accurate I and that all pIjmbInd'.'W;0rk and Installation performed under the permit issued for this application will be In compliance of the Massachusetti'ttate Gas Code and Chapter 142 of the General Laws. 4. By Type of License: Plumber Title 0 Gasfitter Signature of Licensed Plumber or.Ga! City/Town Master License Number 8691`7 APPROVED (OFFICE USE ONLY) tJourneymen All N- i J N- b Date ,).-.�j..-. r.C. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . ) :z.'.l ; �r.. Ai ..................... has permission to perform plumbing in the buildings of . ..,..North Andover, Mass. Fee ! .p, .-.. Lic. .. ........ :`: ;? ........ JPLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date 2—1 S-• 04 Building Location 700 64 ! Gle- o rt t)G Owners Name 144 rt foo e L r v to C Permit #_�Z 1 Amount Tvne of Occunancv iq55 r5T e1 L w rn a 1 New rl Renovation Replacement rj Plans Submitted Yes No FIXTURES 1 q) (Print or type) Check one: Certificate Installing CompanyName K14111f R 0 Ck 7' 1 // C0 t"P ® Corp. /(004 C Address Q O X % 26 Partner. Ai0 - to r)d oyet- , Ma - Business Telephone Q 7A ct 7 S Q 2 Q Q Firm/Co. Name ofLicensedPlumber 20b cr+ Nanch ef-f -e Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box Liability insurance policy Other type of indemnity [3 Bond ❑ 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 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 Mask usetts tate Plumb' g Code Ch 142 of the General Laws. By: Signature of Licenseaum er Type of Plumbing License Title &S 7 City/Town ►cense NumDer Master rV1 Journeyman ❑ APPROVED (OFFICE USE ONLY Location 7o,, (414�c''A-r7, i�C,,— 42f vj No. Date S� 8087 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee bE)t,c o $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 3P-5=" Building ector Div. Public Works P. -miter iso 388 J APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. v il PAGE 1 I MAP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE SUB DIV. LOT NO. LOCATION 17906-104-14dw/44�/1/046� 67f- PURPOSE OF BUILDING C-Ea�sT�= {1� V 9IWNER'S NAME d / ✓o `,' [I NO. OF STORIES SIZE OWNER'S ADDRESS ' /L, j BASEMENT OR SLAB ARCHITECT'S NAME/_��� SIZE OF FLOOR TIMBERS IST 2ND 3RD IfUILDER'S NAME L O pi -SPAN Qui -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS "" POSTS DISTANCE FROM STREET 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 MATER;AL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS ( 00 SEE BOTH SIDES ' O PAGE 1 FILL OUT SECTIONS 1 - 3 Wk PAGE PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR /Do 4* SIGNATURE OR AUTHORIZED AGENT F E PERMIT GRANTED r% 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COS ` FJ/ ���r� Oro EST. BLDG. COST PEREST. BLDG. COST PER BG. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. # CONTR. TEL. # CONTR. LIC. # H.I.C. # C� X7705 mos BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION CONCRETE —I 8 INTERIOR FINISH HARDW D B 1 2 �3 CONCRETE BL K.PINE BRICK OR STONE PIERS PLASTER DRY WALL UNFIN _ 3 BASEMENT AREA FULL FIN. B -M'T AREA '/. 1/1 1/1 FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS II 9 FLOORS CLAPBOARDS CONCRETE EARTH B _ 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING _ HARDW✓ D COM/,AGN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. 8 FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I- I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. I2 FIX.) WATER CLOSET _ _ FLAT SHED ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 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. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS B'M'T 2nd ELECTRIC _ t:r 13rd NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 166 v� W � o c y-- 0 o a ° C y C3 c C o .. < 010- u O u. v cn U z .. co O w O cG L) L U m G is HoH W � p a mW G x w w p w uG Cf) w" p O w G w w A w 7 cc z „ ,~ cn v Q o E cn �• c y-- 0 o C y C3 c C o .. �c y ea VVV O i �• c y-- 0 o C y C3 c C o �c y ea VVV O i Ea • V �. ) U �: • 03 n Q: � o a)s mw o V W L m JCOD ;....E- :' O q' H CD .� r=; Wo � N � •: �� y=. r D C •CoQ .00h m .: 0 CO) O v.;Z � O 0 y C cm 'C Q 2 m : w c N C L. m W C ms� � 'h co .o tv C = o H W N .E v o .m Z c = •0 y •OCD H c 0 GMC i O l u O fU C7 z k,A F� u C i :s �j o a� cm CD w\ •� E CD �E m m i W L CC O Q E: �a y C C CO O CJ J -0 o CD C Z CD 0 CL V y 'C C CO) J Q z I cc LU CL z z LD w crQ >Q /LU V /> z U M J Z z L.L LU C-6� z \ z cc: z W W CL U) _IFF'-.1-�`•... 'Irl = ' rr , FPF!'-1 1p1p�•�1, CERTIFICATE OF INSURANCEISSIIC OQiE (IvYrdIL+D''✓Y, PRODUCER INSURLO t SPIT 7�AN J; THIS CEPTIFICATE IS !$SUED AS A MATTER OF INFOFi?AATION ONLY ii4D CGNFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMFNV, FYTEND OR Al -TER THE COVERAGE AFFORDED BY THE POLICIES SE:LOW. COMPANIES AFFORDING COVERAGE 17 .., ;0\ct'n.�•.' ^ r'rL;NE.."., .`'rl f (',,",>•.'DA>;a covl:;r:AGEs THIS IS TO CE RT IC`"HAT 'HE P^ :^,I!S 0 'NS URA` CE Li'_=•TE0 C.ELO?l HAVE P.EEN ISSUE,J TO THC-. IWr>UPEU NAV ED ABOVE FOR THE POLICY PERIGD INDICATED, ANI,' REOUiRF. SENT, TERNI OF'Cc,; vJiT+r)*; ,,F Arrr CONTRACT Ori OT,'EF, DOCUMENT Wt -,H RZSPEOT TO'yvIllCii THIS CERT'Fi;;A?E ACHY 9 ISSUEC �t MAYR! RT,'," 1 TI -1= tl:[ FA'J-E AFFC:,DE'3 SV 7HE POoC:CS DF.SCR'RK) HEREIN IS SUBJEvT T -D ALL THE TERMS, EXCLUc;:Ct•!c 01:C C!' :i''i0"C C' Sucp P(?'_I'-IE^MTS ''1N? f„ y + �,:c . n, r. r o L hc, •!, E'sFE J D'JCED CO TYPE OF INSUItA.NCF cy r^V PULlCY EFFECTIVC P041CY FXP1RA-IOfv L MT$ ) a 1C , GErIERA t L Ir �• COVVERC"r, ;F'dER.1t. ',.!r'r,P.'" F•d�GU 'TS t?',✓F:C)�' n 3 y1�11L't f;L A VADF ��rC':R .. ; Y-. .1�..�� Frlr;laldAL R kLn, Et,Gr: C O CL•f{pE^rGE 1 (+ ? ' , �1'i11. � X " e:,1 • N, ' t , t•; E ua•,..ACF ,A,y a,o trrj IT, g , S 'TED. EXPENSE (Arty erg pc -o.,) S �C5 AUTOMOBILE LIABILITv C:'�416r<FOS'ti'C1E v n WL OWNIE. Al•;,;; ; SCNEC'IILEp ,�I•lY!:;; pE'.�1 � t , .� n: ::. v � r+c..7;.�wrgINJURYr,tll BODILY. A H'NFr) 80D!LY 'EJJUt'Y CASIAGE L•A61LT. A LQ;tUtV EACH �_C_C�JPPEXCE$$ ENCEL ..._.._..... UycaEU_A F,!PA 0 r P 0"HEP i`+F 1. V,"D?EIL+:, rCR!. 1Y;+RYER'SCOMPENWi7 ,N UTA1'0rORYLR:'Ia,� AND �•OiJi����.j!�1' r�" '+1.^.r 7.n� Cr FACHACCILF.NT �'9EAa8—pULICI' „M t : L'O� , li 1'J EM>LOYERV L'AUILTT1' O'SEA3E—EAGM EMPLOvEE g i,,GD;' OTHER ._-•.-. .m,.. ,,..,., . .-..�,...,.....,_......_ OESCRIFTIllON OF 0PEF.AT'0NS/L0tW ONSrVEAK;LE51SPECIAL ITEM p t X177 n t CvNF B?s (�)lill�k j1C 1 I, C P'1TY•1, F,T 71;!l ,.,.I'KB'1!b RJAD, N. nN;t,i'1M7 I)ir,j;l AnKTllAL iNSURK: 700 N. rNi V 777 t C' 11 s: C^ ,, � ,fi., i�f `(AIN S ... �, x+;'1 4f;B, MG .. CERTIFICATE HOLDER CRANSSHAW \CONST UT:C.0 '92 PA us AVE NEW?0 , HA G2113G ACORD 25-S (7190) SHOULD ANY OF THE ABOvt DES^pIBED POLICIES BE CANCELLED BEFORE THE EXt'IRAT,!QN DATE THEREOF. "!iE ISSUING COMPANY WILL ENDEAVOR TO C)A.YS Wt ITTFN NOTICE TC) THE CFRTIFICATF HOLDER NAMED TO THE LEFT, $VT FAILURE TO MAIL S CI4 NOTICE SHALL IMPOSE NO OBLIGATION OR t.'AWILITY OF ANY KIND �JPON THF COMPANY, ITS AGENI'S OR RE?RFSFrJTATIVES AUTNO EVP SEN*ATIVE ?:IACORD CORPORATION 1990. TOTHL_ P.0 ' NSTRUCTIM 1. All s�'ions of this fcrm mtst tz cc-pkted in Order to amply write dl -"e Dep2rtment of Errvironment2l Protection nctificaticn re—quiremer:s o#310 . CMR 7.00 2. SucmR aiglinal Form To: Commornr921th of Massachusatts Ashastcs Program P.C.9. 120087 Boston, MA 02112 003 kf2zachusettsDepartment ofFnvlronmcntal Arofecflon* Buredu of Waste Prevention —Air Quality BWP Notification Prior to Construction or Demolition Applicability A Construction or Demolition operation of an industrial, Commercial, or institutional building, or residential building wish 20 or more units is regulated by the Department of Environmental Protection (DEP), Surzau of Waste Prevention —Air Quality Division, under Regula- 13 Gen e�a�1 Project Description 1. fac:7rrf tions 310 CMR 7.09. Notification of Construction or Demolition operations is required under 310 CMR 7.09 (2) tenkJO) days prior to any work being performed. The following information is required pursuant to 310 CMR 7.0 _....—_... _.._.__..... ........ _.^^................................................................. Name _...... 'r..._.._ .�01��C1N l�v Ac-e-.ss_....._......---.•.'��..... ......... :..:::...::......... ry.l 1) ......... 3............................................................................... .......................... ..._ Sile ....tp s l' ............................ ....................... SGUeIe �= .............. L �S 1.0.E ......................................................... Nv;n;.�r ur r:;x'r. ........................r ........................... ------- *................. .. ............... Was rBe ra ::r ;..,or A 1987.2 Yes C NO Current or prior use of facility: 1 T -e ...... ...— .... _............. Is the Facility a residential facility? O Yes l No If yes, how many units? Facility Owner lYt?1�J."jOtVNsrre 0— A:p S s eN i o�2HOU JV ..('ete.D...�/��_d/e,.2.�L�`rl' Address — -- ew vi Crrj/re to Telephone U�-sik Ala�ager ................. 3. General Contractor .1>i,.V S.K u�..... .o...N...S. 1�U.c `D. ....... D .................................... Ndr,r P���Ai �'� ��15� --._. 11).6 ............................... - r;" I Massachusetts Department of Fnvlronmental PrOtBCtlD17 , Bureau of Waste Prevention —Air Quality BWP t AQ Notification Prior to Construction or Demolition 93 General Construction or Demolition Descrip-tion 1. Construction or demolition ccntra(.or If yes, who conducted the survey? . ............. Q.YU{.... .......ft S......... ........ :3... ....................... G�r/Tca, Te!e;;hone - Ce�r. Gtabor and way'ries Cyurtajon Nisar (/) 7. Construction or demolition _ Sit Lo'e c;d DXe 2.._Cn Site Supervisor 8. For demolition and constructionp rojects, indicate dust _ suppression techniques to be used: `T.!.��.5..... .. ...... ................ (................ ......... . Is the entire facility to be demesished? X Yes C No C, seeding G paring wetting IJ shrouding covering ❑ other .................................................. 9 For Emergency Demolition Operations, who is the 4. Deal^be the area(s) to be emclished: St -'e ............... M..n.lII. _N....�ocal Official who evaluated fi e emergency: Or ........................... r%e 5. If this is a construction project, descri� the building(s) or ......... ....................... addition t be constructed: AL;;;oral - N _ ........................... &,'e olk1horirafion .............................. _................................. _......................................... ....................... Cir Haw.rJ 6. If this is a demolition project, were the structures) sur;eyed for the presence of asbestos containing material (ACM)? Yes O No (General Statement: 4 asbestos is found during a Construction or to, filing an asbestos removal notification with the Department Demolition operation, all responsible parties must comply with and/or a notice of a releaseAhreat of release of a hazardous 310 OR 7.00, 7.09, 7.15 and Chapter 21 E of the General Laws of substance to the Department, H applicable.) the Commonwealth. This would include, but would not be limited ' Certification a� s &Kw1 certify that I have examined the above and that to the best of - z"" ' "'' ,t ........................................... My knowledge it is true and complete. The signature below' subjec.s the signer to the general stables regarding'a false....... alse' -.................................... ••� uR�.�a,itKe and misleading statement(s). —....................... F��ix,/rter /1 I � - r Z�SZFZC�T%C�f ©g D.Z`%YC�-Anj: c�.�33C� OPE.RjTOX PROJZC'= 4 ` : POSTliARl�i DATA AZCC3 biOTZFZCATIO4 • Z. TYYS OF NOTIFICATIO-0 ; 0-01101NAL R-RXVIUA ��� D )• ftctioo? IZ. FACILITY INYO.MATIOK Q iDL7iTITY OxrERv TztsOVAI. COW-.pACTcat Mm OTHIR OPERATOR ck-KMA NAnI D i NI e� SSI'i �i� ti i ec �r Pq lklf/ Wo ADS Sew10 " tITT! QA M l3 k i n Ge STAT" (uA SS , aI�! 0 CON i ACT SSL, gL3dOVAL CONTRACTORS 6 TH 4 i i u T(Ye- L u vc j IDDR=SS! dl it L' c-6 s; i�v 06K T cCx-.Ac:,LlR i s 19 . T/ 7 d- s 3AIJ 0TR30t OPERATOR S6 k 1� 66V e !►DDRt3S! e -A -k= I tI?, CJ�t'..�►CT a mss, ZZI. YP3 OF O:ERATION ( P-Pxm O-CEmaxaD D•IAO A-i�seovnriox sus R.ErNbvLIOA )t� Iv. Ia ASBESTOS PP-vS :NT? ; Y33/vO) C, . V. FACILITY DESCRIPTION ; INCL"l IIOILDING sAMEt MUM" AND tLOoR OR 140" xUMM ) DIDG AMCt 2 y I c- AD��st adv crrx! V (l ssa-s, �r COMM E1= IocuIcst ,S/9MLo BUL=INO SIMS� (}r7"C� S NVti Or r7�ORSt A= IN U"St ?IYSXNT USI, ! C A N — 2AIOA II8Et (� e . VI. PROCEDURL, INCLUDING ANALYTICAL XETSOD, Z: APPROPRZA S, USED TO DETECT TEM pgggE C3 OF ASBESTOS MATMRIAL: - l ?2II. OC,"-PULLD DAT" -3 A-55Z3T'OS ItMMOVAL (xrz/Ln7/aY) Z Tt CCtQLalit BCFIMMED DATrd DZX0/AZNOVATI0W (xWD0/2t) asa RT: S_ coKrLa ist COEtf-MZAA OA PLj& t1Ai 1 jf dZZ. APPROXIMATE AMOUNT OP DON21IML2 ASBESTOS, INCLUDINOT AEnas;oa Wk-.ZR=,X0T MA b. P3=UTID ACK :V SB RIliOVID R74C3i TO BE MOVID 2. [1=0032 I EGM NOT EENMD TO IIs 3. C�OORT II 1CM AOT xL?oom r.t RE21C1V3D CAT I G7 II PIPIG es e itn54 VMS VOL )tAC3( OPr FACILITr �NEyT ftr ?2II. OC,"-PULLD DAT" -3 A-55Z3T'OS ItMMOVAL (xrz/Ln7/aY) Z Tt CCtQLalit BCFIMMED DATrd DZX0/AZNOVATI0W (xWD0/2t) asa RT: S_ coKrLa ist COEtf-MZAA OA PLj& t1Ai 1 jf V(71'I CA=( $i -07 p3mLIT2CSi ARD A=O VITION jccaLl1' 4di D23CRI7TIOX Of P7.axxEa DE240LIT300 OR 9 ZMWATIOt( # ANIP NET30D(!)- TO 24 U9EDk:. n o Ni.t - Xj. DESCRIPTIO 03 WOM MCTICS3 AND 3NG NEER.IN0 CONTROLS TO 83 USED TO PREVENT EIiIS8ZON8 OF 319S88T0$A7 T DE)40LITIO3 A2iP REHOVATI02i 87"s XII. wAST3 TFAH320ATER 11 0 r :MAXI ! CI;7! CONTACT P3R S �RIS WAST3 Tit s?oRTrR 12 3ia?i3! (c S f} f4c f -. L ADDR288! , CITY! COJITACT PSRsom XIII. VXSTL DISPOSAL SITZ STaS78 Zi3t . Y^tr.3Paesz, CITY! ^, A"T"aZS'.TD2NTlT7T== IF DEMOLITION ORD=D B3 A GOVERNM-7WT AGENC:, PLZAflBELOWS XAKR1 �/M TI7L31 .%XT8oRll•T, DaT3 OF ORDER (xKnD/3T)! j DAT3 ORD3RED TO 320" (KKhDITY), XV. FOR ZMZR=CY It-", OVATIONS N A IN%= AND 2" " Z)a a (M/DD/zZ), /v�� DaSCRIPTrcT( 07 Ta SUN=, UM=ZC=D TYS.nz, 3I21A}tATION C7 XUR TA3 3:'S:T C. szo UASAM Mims VOR WOULD CA11S2 2QU12 = DWZZ OR AN all A503tA3L2 71XAXCM 11WIZaa, A XVj. DESCRIPTIOS OF PROCEDURES To BE FOLLOi-7SD IN THZ, EV`i!AT UNm"ZCTED A.SBESTOS IS "UND OR PREVIOUSLY NO IAB ASBESTOS nTEAZATj BECOMES CRUMaLED, SpRIxzD' OR,1RL DUC D TO 3004 ZB .�(� t., 9LEL to Ia c , YVII.I CERTIFY TH.1T AN INDIVIDUAL TRJUNED IN Tx3 PROVISIONS OF THIS REGUIiii 3 (40 CFR PART 61s BUBPART X) WILL BE ON -SITZ DURING THE DEMOLITION OR RENOVATION AND �xC� THAT TH3 R:QU= STRAINIyo BASk BEEN ACC.O�I.IS +I.ED BY THIS FSR.SOR X= B3 AVA ?OR INSPECTIOH DARING NORY.A'L aUSI2iSS3 XVIII. I CZRTIFY TEAT THE ABOV3 I27FOR?SAT 7CT r {SIG2:?,TURE OF M'lZR/6PZitAT02t) 2.1 M.Q.H I 1 1 7 D A Y ST G A S,- L- A W R A N C E P Bay State Gas Company Aupst 22,- 1994 North American Cont. 218 Lincoln Street AllstonMassachosetts 02135 :TO wHom IT MAY CONCERN: This is -to inform you that there is no gas at 700 Chickering Road, North Andover, Merrimack Valley Motor Inn, and the building may be demolished. Very truly yours, BAY STATE GAS COMPANY — WRENCE DTVIS10M William J. W i e St. Supervisor, stribution Post -!t' brand fax transmittal memo 7671 PC qp C 0 55 M;v:r1c)n Slq,,ol PO '. I 1W) I :I, fI ` reement N1 a C PESO' CONTROL Back Bay Annex F. 0. Sox 123 BOSTON, j,1,�SSA.CHUSEiII S 02117 Phone 361-5122? -EavicE LCCA :--.4 i C..3'^stEn i; 218 Jincalr St ;j 54-3140 8-25=94 0213^_ Fax r 25�=-3Qo, One Story Motel .,� e dents rocan s zzcr:r.d . 7 North Andover, Ma. -M1 ;a Dan ru 3£Rv10E ro BE PEPFOnMc6 C MCNTHLY G QUARTERLY C OTHER -I X - .r N01TICNS-. _—_— i� I� $cnVICE GUARA�l7�=_ We agree to apply Chamicals to control above-named pests In accordance With terms and condition3 4 this .`'-EFm Agreement, F,II labor and materials will be furnisr�cd to provide the most efficient pest control and maxtmurn safety required by — i fedeI, state and city rogulatlons- — --- — __ ---- —_ — — S� YICc RENEWAL: tni3 agrear^ent shell be for an Initial perlod of ons YOU and Will tsn2w itself annually unless atther party CanG3i, t^Is agreement by gluing thirty days written notice before any expiration Bete. AN,,WAL :I ,rGNjEc,ITCHARGE BY i � 1; DATc—� _•— ccMP1VY aai2YS. 0:l R� I�iiT1AL SER~VICE C APG= n n ^ ?.1aai !L'iiCU�?icFst(pAYl�i�':i� C FOR D PIT c c isiaMER _'—y T 510NAPE) IfA: a ... r N w Location 0 O Na, - Date ion O J �oRTh TOWN OF NORTH ANDOVER F ., % Certificate of Occupancy $ a • * > = Building/Frame Permit Fee $ Foundation P rmit Fee $ s�cNu � a �,. ee $ r-2�- = i SewerConnection Fee, $ Water Conn ,ion Fee $ TOTAL ,! > $, Building Inspector 7779 Div. Public Works PF .11IT NO. -133 7 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 " AP d�0. LOT NO. 2 RECORD OF OWNERSHIP 1,DATE BOOK 'PAGE ONE I SUB DIV. LOT NO. I— LOCATION 17170 UIC e f` - `6 A- PURPOSE OF BUILDING G`TOP-P C "M -R, L` n OWNER'S NAME N`4_S `•1`t.p a �LI5- f /`REN kL NO. OF STORIES ' 1 SIZE 71 1 IL OWNER'S ADDRESS ��/'� c 1` BASEMENT OR SLAB ARCHITECT'S NAME p (' cS SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ELEC.TR�Itr✓AL l Nr`�U,1 jCSPAN 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 % 'B.B 1LDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE SEE BOTH SIDES INSTRUCTIONS PAGE 1 FILL OUT SECTIONS 1 - 3 tq%WGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 'Z- S ` 14 SIGNATURE OF OWNER OR AUTHORIZED AGENT V F E E R5. "o-7y PERMIT GRANTED vJ� 19_ 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNERTEL.N CONTR. TEL. # CONTR. LIC. # H.I.C. N -7 -7 -7 1? - SEE BOTH SIDES INSTRUCTIONS PAGE 1 FILL OUT SECTIONS 1 - 3 tq%WGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 'Z- S ` 14 SIGNATURE OF OWNER OR AUTHORIZED AGENT V F E E R5. "o-7y PERMIT GRANTED vJ� 19_ 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNERTEL.N CONTR. TEL. # CONTR. LIC. # H.I.C. N -7 -7 -7 1? - BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STOk1ES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION CONCRETE 8 INTERIOR 3 HARDW D PLASTER DRY WALL UNFIN. FINISH 1 2 13 CONCRETE BL K.PINE BRICK OR STONE PIERS _ 3 BASEMENT AREA FULL FIN. B M AREA _ 1/1 1/2 1/1 FIN. ATTIC AREA NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS 8 _ 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME HARD"J D COMMON ASPH. TILE BRICK ON MASONRY ATTIC STIRS. 8 FLOOR BRICK ON FRAME (— CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR POOR _ADEQUATE I -i ONE 5 ROOF 10 PLUMBING GABLE GAMBREL HIP BATH (3BATH (3 FIXE MANSARD TOILET RM. (2 FIX.( _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 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'T 2nd ELECTRIC _ to 13rd NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 4 v 0 b j CN r-1 0 z Imt ui om Q y W_ W H m W V H m c 1 N A Er m�� mm a a z W w O w z z ry", A E_ z Q G n u C. w aG '\O y vU b to app �i u w O Q w v 2 O v w cn p O L C w a: U w p G r� w p v C rx cn w" 0 r a w w O CO cn cn Imt ui om Q y W_ W H m W V H m c 1 N A Er m�� mm a O N CD NN cm No rT' ry", m -� � n C. LQ :ECA m oE—' CD ac3 � m o'oa cm C - .5 W a. C oz O C3•5Z • C � O O O- CA C_"' O w+ N O w0,. ~ C ev O G y .W = :5 C . =c 'E cO y.a .... , N cm C CD O CD O c L � o o v Z O C. O CO) co cm0 I � C caCD p -C .y O .O E mm CD O i CD CD 0 0 0 Q o- as Q y 0 rte-+ C ccC CJ J .O �O_ OCA C Z CD C) y c c h 0 z 0 Q W C/) z O U Location Z -w Lf 641,ga No. V, Date / o q N°"'"4, TOWN OF NORTH ANDOVER ? • O ►°3ALamdik p Certificate of Occupancy $ IP Building/Frame Permit Fee $ 293b5 Sv JACNUS t Foundation Permit Fee (b: $ — ¢S5 v! Other Permit Fee $ Sewer Connection Fee $_ ^ Water Connection Fee $ yhq,-- TOTAL $ Co o ' ' /9Z Buildin ` e'ctor 7639 9 Div. Public Works 0 I �,>( Location 70D No. Date 10-6-94- 0 oS-9 MORTN TOWN OF NORTH ANDOVER Of,•1O '�,�0 O? •' • Off' „ Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ,Ss,1CNU5Et Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �lnspe o Na 8408 4DIv..Wortksr Location A(7, No. 44, AA f�3�12 Date 'f TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ 55-V0 Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ f S� Building Inspe or 4 1.40 P.1ID 7560 ! 5 6 0 Div. Public PERMIT Np. 4 itPPLICATION FOR PERMIT i w It MAP d40. LOT NO. I 2 RECORD OF OWIv..� l - PURPOSE OF BUILDIN ,e Ir NO. OF STORIES SIZE BASEMENT OR SLAB <i w �. •. V `XJ' ZONE17 SUB DIV. LOT NO. LOCATION ( /�, ry��-� , OWNER'S NAAEA.� ^�r����Ti'U /��� OWNER'S ADDRESS /,/^� J` /yt I Ly1R. ARCHITECT'S NAME �� 1 SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAM ^,oS s/0y, t&r7- Qr�p 7- SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS "' POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION t/ ��j. _ _ /ns k7000(� THICKNESS G �� IS BUILDING NEW LA -S - C SIZE OF FOOTING /� toiC X IS BUILDING ADDITION Ala MATERIAL OF CHIMNEY - IS BUILDING ALTERATION A/ /0 IS BUILDING ON SOLID OR FILLED LAND Sol-, O WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Yrs C J IS BUILDING CONNECTED TO TOWN WATER v f'S BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER c IS BUILDING CONNECTED TO NATURAL GAS LINE' r S ONIK INSTRUCTIONS pERMIT FOR FOUNDATION ONLY 3 PROPERTY INFORMATION REGULATED BY PARA, 114.E -S. B.C. LAND COST SEE BOTH SIDES EST BLDG COSV d40 PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 s Na EST. BLDG. COST P& SQ. IPT. DATE 12- :14- FEE PA ID ST. BLDG. COST PER ROOM . ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING pERMIT FOR FRAMIIE/BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING IN1� TIQR, 11 54 --FEE PAIL 9-I GATE FI /O ^' ��' 7 w '}GGATURE OF OWNER OjkAUTKORIZED AGENT F E E 3�s Sa PERMIT GRANTED MONO.---- OWN— PERMIT Ill 28 '3S -C' y0 LESS FDA FEr _. 455• WE FRA! r r +^ I1 �rJ►1T aso :::.. $�4 SEPTIC PERMIT NO. 4 APPROVED BY CONTROt WNSTRUCT04 BUILDING INSPKCTOR OWNER TEL.# 61%- ygV-//10 CONTR. TEL. # tpoo ��S��7,2,3 CONTR. LIC. #. H.I.C. # �� i 359-• _ 75% BUILDING RECORD y 12 S THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM I _IoFFICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION i 2 FOUNDATION I 8 INTERIOR FINISH CONCRETE_ la 1 2 CONCRETE BL'K PINE BRICK OR STONE HARDW D PIERS PLASTERI �j _ DRY WALL 1 UNFIN. 3 BASEMENT 11 AREA FULL I If FIN. B M'T' AREA 1/1 '/I 1/1 FIN. ATTIC AREA _ NO B M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS II 9 FLOORS CLAPBOARDS CONCRETE EARTH HARDw 0 _ COMMON ASPH. TILE B 1 22 f 3 I_ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME I_ CONC. OR CINDER BLK. WIRING _ STONE ON MASONRY STONE ON FRAME SUPERIOR POOR I ADEQUAATE ONE 5 ROOF 10 � PLUMBING GABLE )C HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET — ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER i3 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'T 13rd I TRIC NOCHEATING ; L. 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H (T i = Z > p WOE a w v~i O LL wt �rcT a T" ul z o LL c to 7+ Q .O m F�C!.0 0.Lrn V LU C LWE N Z � O Z a G S - �Gc= A r p 0 cz F' �C7 66 'Q=w w ON a Q W ' LL I �r W N 00 M 3LL= �c Z s Lu 0a o N ° 1. z a G Q z `�.O O Mcr �= w Cc Q X r� N a o W S-��7z- FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLI CANT :/& , S,6:y/C).+� f�Gwsl" /L' LOCATION: Assessor's Map Number 08_ p Subdivision Phone Parcel Lot (s) 0000 Street e111 e- A � 1A46 ,QUAD St. Number ?D o ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspecctor-Health :� SCJ fly.t� Septic Inspector -Health Comments Date Approved �r Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved d Date Rejected Public Works - sewer/water connections —/:.7_0 l0 --,5 -%,�r d Fire Department Received by Building Inspector Date 4 Jgo� OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER 508 682-6483 x30 " CONSTRUCTION CONTROL `,SS wC MUSIC . PROJECT NUMBER: 93736.00 PROJECT TITLE: Heritage at North Andover PROJECT LOCATION: 700 Chickering Road, North Andover; Massachusetts NAME OF BUILDING: Same as above NATURE OF PROJECT: Multi—Family Housing for Seniors IN ACCORDANCE WITH SECTION 121.0 OF THE MASSACHUSETTS STATE BUILDING CODE, I� Maurice F. Childs Jr. Registration No. 2067 BEING A REGISTERED PROFESSIONAL ARCHITECT HEREBY CERTIFY THAT I.HAVE PREPARED - OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICA— TIONS CONCERNING: ENTIRE PROJECT ® ARCHITECTURAL Q STRUCTURAL r__1 MECHANICAL Q FIRE PROTECTION Q ELECTRICAL Q OTHER (specify)CD FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE=APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES. AND APPLICABLE LAWS AND DRDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND .BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING - PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN .SECTION 127.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for -conformance to the design concept. 2. Review and approval of the quality control procedures for all code—required controlled materials. 3. Special architectural or engineering prof essional. inspection of critical construction carponents requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix B. PURSUANT TO SECT -ION 127.2.3, I SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVEEL BUILDING INSPECTQVqnWA".. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO ,�ii%�ATISFA. COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. ` SIGNATU SUBCRIBED AND SWORN TO BEFORE ME THIS DAY OF I Commission - Expires Sept. 28 , 2001 NOTARY PUBLIC MY COMMISSION EXPIRES Y �o CCT 16 3: •� OFFICE OF BUILDING INSPECTOR .• TOWN OF NORTH -ANDOVER.. e- CONSTRUCTION .,CONTROL( -508);682-648 3, x30 PROJECT NUMBER: 93736.00 PROJECT TITLE: Heritage at North Andover PROJECT LOCATION: 700 Chickering -Road, North Andover, Massachusetts NAME OF BUILDING: Same as above NATURE OF PROJECT: Multi—Family Housing for Seniors IN ACCORDANCE WITH SECTION 127.0 OF THE MASSACHUSETTS STATE BUILDING CODE, I, Thomas Rona Registration No. 18595 BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I.HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICA— TIONS CONCERNING: ENTIRE PROJECT ® ARCHITECTURAL Q STRUCTURAL ® MECHANICAL Q FIRE PROTECTION[D ELECTRICAL Q OTHER (specify)Q FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE'APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN.SECTION 127.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for -building permit, and approval for ccnforrrenc:e to the design concept. 2. Review and approval of the quality control procedures for all code—required controlled rmterials. 3. Special architectural or engineering professional -inspection of critical construction ccrrponents requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix B. PURSUANT TO SECTION 127.2.3, I SHALL SUBMIT WEEKLY , A PRdGxES GETHER A WITH PERTINENT COMMENTS TO THE NORTH ANDOVEE, BUILDING INSPE'���, UPON COMPLETION OF THE WORK, I SHALL SUBMIT -A FINAL REPORT AS T �. COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. '01S SIGNATURE c►4�� ASUCRIBED AND SWORN TO BEFORE ME THIS _DAY OF 19 NOTARY PUBLIC y Commission ExpIt'E't* ?.8. MY COMMISSION EXPIRE �� 17 '94 b�:57 NATIONALDEVELOPGRP' U4 %Jldf ChUds Bevux i TscdArw f1w. 306 Dartmouth Street. Bolton, MA 02116.2201 7-elepwnw (617) 262.45-14 ,p"acsimlU (617) 2.36.03781(617) 424.9127 . AichilecYure . Space Planing and ivdiorArchtlecture Urban DASA and PLOW , To: ...... Telefax No. `. ... ... ... . P.Ci2 TELEFAX COVER SHEET AN9y-e�j From; . / ��� ,r ' �!;.,.,,. ...... Job Name.: !• • • . Job Number� . • .. ... .... . Special Instructions:/ ............ ... • ........... c�.�v!I. ....... , f�....,�.7�......... . ............r•,,,�,... .�.,�.............. ............... •,..,� -................................... . ...... ....... I ...... ..... .. .. :.:::.:::Mi .... -114 'o:ta:fir:)29 te : WX6- ..�� ... . e't.17Z -Y) ............. ..... ' :..r.r.07w 4..hof. o do. ....... � .... . ...... ...... .. _ t a 9 6�5"�2 Pages to foliow:....... ........ `' If you have trouble receiving these pages, please call (617) 262-43.54, 0 Hancock Survey Associates Inc. 235 Newbury Street Route 1 North DANVERS, MASSACHUSETTS 01923 (508) 777.3050 (617) 662.9659 (508) 352-7590 (508) 283-2200 TO CRAN5I4AW CDK)STe t, OF NEW EKUM I c�q WQ,L6 AVE LISW T aN CENTrze I "A WE ARE SENDING YOU I Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE ' Q � � � � , t JOB NO. ATTENTION DATM�^ ��/� Q� t��-f+ � RE: C F_� 1 I I 1 D l `—'O T ` C AVQ ^ — 4EI2tTAGs @ tJOP:TH ANJ00VEK- As requested ❑ COeEJ CM -FI Fl O QI,07 RA -Q ❑ 0 Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION As requested ❑ COeEJ CM -FI Fl O QI,07 RA -Q ❑ FORBIDS DUE THESE ARE TRANSMITTED as checked below: ❑ For approval For your use As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit ❑ Submit _ ❑ Return _ copies for approval _ copies for distribution corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US SEE(._ �tZE� LL bU COPY TO N'S A, FI LG RECYCLED PAPER: Contents: 40% Pre -Consumer • 10% Post -Consumer SIGNED: if enclosures are not as noted, kindly notify us at once. 41 1 � i 1 1 Ift A 0� Q ® OZ N.J �° b P o �• o rz Zr-11W RZ tiz a p� O � O owe h� �zQ Q x s 0 0o W p �Q Q QO mti o 0 to �D�ZZ � W WWW�J v y I oo O0 J Q W tz W�Z W ZQZZ UTS\ j tiZcc � y C` e o ;v n sr'v �``S oZZj W Qov� Q N � Z .y„ Qz 'd- �� ��Qo IN o L QvZ LIJ 40 IQ o Z ti a6 i V Q Q qRLZ �pz IM.. QpQoW �W m� OJ Z PQ �z s 0 0o W p o VW wwQ 'lam. m +4iZZ .Q Q���Z o WWWQQ W v oo�� � Q Q oo�z 7 �pyZ trs oQ -Q06 CQ • �o . Q 3 � �`t�a� ��a ti IRK Ods OQ�00 �OC�Q O 0 N �tiOZ Q jqe ~�wti D� �P WQWz W L Q�z I • A WW �Sv� V ZW � 'c' do �LIJ � J� �? Q � LL- jj- ti' WQ JQ o. � D � � � ►� ►, Q J Ja` Q o � N3 �L m 0 h W V V S o mti �g L-Aj 0 LO Q titian �m. n c :01 :PI4-77Z W � cz � V °�. `' Q W o a�Q 2 z �-7 ��, i-� w� Q O & I, yN,)5L�Is o M Q o�Z� W ZOC��Q O m N 0IZLki a � P zW� tiN � 4 QVZ CERTIFICATE OF USE & OCCUPANCY Town of North Andover TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES AUGUST 31, 1995 Building Permit Number 446 (1994) Date July 14, 1995 (Model Lobby 122 & 125) (Model Apartment Units - W101, W102, W103,W104, W105, W106, W107) THIS CERTIFIES THAT THE BUILDING LOCATED ON 700 Chickering Road MAY BE OCCUPIED AS Model Apartment Units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. oT 4�+o CERTIFICATE ISSUED TO North Andover Living Limited Partnership : ADDRESS 700 Chickering Road ,'=„""S Building Inspector Hon OFE ICt-S d : R'Town of APPFS nt_S NORTH ANDOV LIZ CONSERVATION "�aE, 01VISION O1= I -I I:AI .'I 1-1 PLANNING PLANNING & COAIMUNI'I'Y DEVELOPAIEN'I' KAII N H.['. NELSON, I)IfiE (>IZ CERTIFICATE OF ARCHITECTURE BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 GENTLEMEN: I2()M:[if I tilrc't I No]III hUttiti:ic lttttic'llti()1Fi•> (617)66—i,477> I, MAURICE F. CHILDS , HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTTS STATE BUILDING CODE, FOR ARCHITECTURE AUTHORIZED SIGNATURE: DATE: JULY 7, 1995 REGISTRATION STAMP: BROOKUNE, i MASS, i "On O , OFI-IC.L-SOI : 02_.•.....�0°< 'ro YY n of APPEALS NORTH ANDOVER CONSFRVATION `" 0` DIVISION O I-II�AI.'II-{ PLANNING PLANNING & CONIMUNI"I'Y UL;VELOPNII:N'I' KARL -N H.P. NELSON. [ARE -(:TOR MECHANICAL AND PLUMBING CERTIFICATE OF ENGINEERING BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 GENTLEMEN: 1 L��c t t\I.tit t tiUc'c•1 Nc tl 0 t At a Ic t\•c•r. �l:ttiti:tc'Ittitic'll`OIti4 I, JOHN PANITSAS , HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTTS STATE MECHANICAL AND PLUMBING BUILDING CODE, AUTHORIZED SIGNATURE: - DATE: JULY 17, 1995 REGISTRATION STAMP: KARCN H.P. NELSON. l)IIZE(: O Z STRUCTURAL CERTIFICATE OF ENGINEERING BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 GENTLEMEN: I, THOMAS -RONA ?. /►'V/%(' 6Jl r HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTTS STATE STRUCTURAL BUILDING CODE, AUTHORIZED SIGNATURE: DATE: REGISTRATION STAMP: o° eonr r � bFF-ICE.SOF: o TOWIl of APPEALS NORTH ANDOVER NOW i Ai is I()\,(.r. IM11.1)ING •: -�9' n1.��<:u li�itic Iltiutti•i CONSFRVATION ss"BE. DIVISION O1' (G I ) G8514775 HFAI.IH PLANNING PLANNING & CONIMUNI'1'Y UE;VEsLOI'AIEN'I• KARCN H.P. NELSON. l)IIZE(: O Z STRUCTURAL CERTIFICATE OF ENGINEERING BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 GENTLEMEN: I, THOMAS -RONA ?. /►'V/%(' 6Jl r HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTTS STATE STRUCTURAL BUILDING CODE, AUTHORIZED SIGNATURE: DATE: REGISTRATION STAMP: KAIZEN H.P. NELSON. UIREC((M ELECTRICAL CERTIFICATE OF ENGINEERING BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 GENTLEMEN: I, _VINCENT A. DiIQRIO , HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTTS STATE ELECTRICAL BUILDING CODE, AUTHORIZED SIGNATURE: DATE: JULY 17, 1995 REGISTRATION STAMP:Q- OFFICC.SOF: o ° TOW11 of I 'c��I;iiii tilic c I AI'I'EALS NORTH ANDOVER Not [I I Ai l(I()\•(•r. . IW1L1)ING N=: 9 Nt,ltiv,ICI SCIItic�IH•� CONSERVATION INVISION OF ui I 1 (i85-1775)' HFALTH t'LANNING PLANNING & COAIMUNI'I'Y DL'VLLOI'AIEN'I' KAIZEN H.P. NELSON. UIREC((M ELECTRICAL CERTIFICATE OF ENGINEERING BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 GENTLEMEN: I, _VINCENT A. DiIQRIO , HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTTS STATE ELECTRICAL BUILDING CODE, AUTHORIZED SIGNATURE: DATE: JULY 17, 1995 REGISTRATION STAMP:Q- Wig C01tu110ntueu[tij of �I�l�gacijil�cett� CERTIFICATE FOR USE OF ELEVATOR UT,Chapter 143, General Laws, as Amended. DEPARTMENT OF PUBLIC SAFETY- ELEVATOR DIVISION ONE ASHBURTON PLACE, BOSTON, MA 02108-1618 Located at %d-0 C14 l C rL R 1 IJG Re , A o Pri q AA Ny a Capacity: -5`60 Pound State IDN: 41,6 /o Speed /SO Feet Per Min ZIssued On: Inspector Fireman's Service & Emergency Generator Test: /V IN CASE OF ACCIDENT NOTIFY (617) 727-3200 AT ONCE. AFTER MOM 4 WEEKKNDS w;,,� D. LU CALL (608) 820-2121 OOMW8910NER FORM ELA GR4 ufl9l)e C01111ligl1weatti) of odywncij[latto CERTIFICATE FOR USE OF ELEVATOR Chapter 143, General Laws, as amended. DEPARTMENT OF PUBLIC SAFETY. ELEVATOR DIVISION ONE ASHBURTON PLACE. BOSTON, MA 02108-1618 Located at J' 00 C'Kif�',�,e✓� �2D AloR �.vaev Capacity: 0529 O Pound State ID#: 4../D Inspector Speed :! 0 Feet Per Min Issued On: Fireman's Service & Emergency Generator Test: IN CASE OF ACCIDENT _ NOTIFY (617) 727-3200 AT ONCE.. AFTER 5:OOPM & WEEKENDS w wom D� CALL (508) 820-2121 COMMIssIONER FORM EL -4 W94 199 Wells Avenue Newton Centre, Massachusetts 02159 (617) 964-1533 (617) 527-1977 (facsimile) Cranshaw ConstructionNOW Y of New England GENERAL CONTRACTOR FINAL AFFIDAVIT Heritage @ N. Andover 700 Chickering Road N. Andover, MA 01845 To the best of our knowledge, the construction of the building at 700 Chickering Road has been completed and does conform in all respects to plans and specifications and any applicable Massachusetts State Building Codes. Sign Daniel FieEffer Construction Manager Sam Dettore, r. Vice President Subscribed and sworn to before me this tc(I'"da y of TOIL] , 1995. STATE OF: MASSACHUSETTS COUNTY OF: MIDDLESEX Jea AJNO AR PUBLIC My --Commission Expires: W COMI-ABSION EX i5E4V1 XX."'V. Z�, 202 CERTIFICATE OF SUBSTANTIAL COMPLETION AIA DOCUMENT G704 Distribution to:� OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ FIELD ❑ OTHER ❑ PROJECT: Heritage at North A Jmer Senior HOLisiMARCHITECT: (name, address) 700 Chickering mad North Andovexr >A ARCHITECT'S TO (Owner) : F_North A rbo Assisted Living Limited Partnership c/o AES Senior Dosing 139 M3in Street LQri ride, Imo, 02142-1118 DATE OF ISSUANCE: PROJECT NUMBER: 93736.00 CONTRACTOR: Cranshaw 031stni-tion of New England CONTRACT FOR: General Oaistrwtion J CONTRACT DATE: Septarber 19, 1994 PROJECT OR DESIGNATED PORTION SHALL INCLUDE: shim building otkpx than 't=b1 apart t twits" previously filed. The Work performed under this Contract has been reviewed and found to be substantially complete. The Date of Substantial Completion of the Project or portion thereof designated above is hereby established as which is also the date of commencement of applicable warranties required by the Contract Documents, except as stated below. DEFINITION OF DATE OF SUBSTANTIAL COMPLETION The Date of Substantial Completion of the Work or designated portion thereof is the Date certified by the Architect when construction is sufficiently complete, in accordance with the Contract Documents, so the Owner can occupy or utilize the Work or designated portion thereof for the use for which it is intended, as expressed in the Contract Documents. A list of items to be completed or corrected, prepared by the Contractor and verified and amended by the Architect, is attached hereto. The failure to include any items on such list does not alter the responsibility of the Contractor to complete all Work' in accordance with the Contract Documents. The date of commencement of warranties for items on.,the attached list will be the date of final payment unless otherwise agreed to in writing. Cgr/Childs Bert m 'fres Inc. /�l:/�.�/July 7, 1995 ARCHITECT BY DATE The Contractor will complete or correct the Work onLBY items attached hereto with' days from the above Date of Substantial Completion. Cxand w CXtistructitn of New R41and Limited CONTRACTOR V *DE The Owner accepts the Work or designated portion thereof as substantially ompl to and will assume full possession thereof at (time) on C (date). 71 North Andmer Assisted LiAM Limited Partnership OWNER BY DATE The responsibilities of the Owner and the Contractor for security, maintenance, heat, utilities, damage to the Work and insurance shall be as follows: (Note—Owner's and Contractor's legal and insurance counsel should determine and review insurance requirements and coverage; Contractor shall secure consent of surety company, it any.) Me Ckaler SI -all talm over all seaety, TC ir±ffl r heat, cooling, utilities, da ager and cleaning as of AJ:St 1, 1995. AIA DOCUMENT 0704 - CERTIFICATE OF SUBSTANTIAL COMPLETION - APRIL 1978 EDITION - AIA@ © 1978 - THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 G704 —1978 ti CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 446 1994 ) THIS CERTIFIES THAT THE BUILDING LOCATED ON 700 CHICKERING ROAD - "THE HERITAGE" MAY BE OCCUPIED AS MULTI -FAMILY HOUSING FOR SENIOREN ACCORDANCE 100 UNITS) WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. SEE REVERSE SIDE FOR OCCUPANCY LOAD. O"'"� N.A. Assisted Living Ltd. 0-0,10" ._.. � CERTIFICATE ISSUED TO g ° C.0 ADS Senior Housding ADDRESS 139 Main St. Cambridge, MA s,�""s� Building Inspector r ROOM DESIGNATION: Dining Room Bistro Community Room Living Room Lobby foyer UNIT COUNT: Studios One Bedrooms One bedroom < Dens TOTAL: ALLOW. OCCUPANT LOAD: 87 47 157 23 408 West Wing: _ East Wing: 26 31 18 20 2 3 46 54 IL w C= O 4 co R O y4 tAJ ' z vl LA- y E eaa t O s w Cq �.:ca ti 4J = o y �- CD L.0 o a y 0 "p Q Go � fA LU An co z > co 0 CD Oc cmcCD f ~}' to cc Z O �y y e �� f V� i2l" CO ;g m L a, �O y CD CL. CL cm< m ..� y C O O �.a.0o c f `' = M Q 4 Cd CO cm" co air,�,! C Z co z CL C.31 q Z c ''� j V y -'- `a o vs '0� p_a• cc C 7 Q m y m c o Z o :03CL 0- - $:w OAF— ._ W WC U.10 Com: fl. cmQ ruj CD OOoe iv - 00 ur Z• o esu �• Ad Z tti ? �s ��i v' A �' t7 Ar J0:. a: m - n f .. . �; w 714 A U O H i m x v 1�./ t 2 v c F.4 U: - N W. /1 1�1 6 Q w z -� a 3°L�00 ,�+ U w .0 aY o v W a ►• v G o. I= cn Vn IL w C= O 4 co R O y4 tAJ ' z vl LA- y E eaa t O s w Cq �.:ca ti 4J = o y �- CD L.0 o a y 0 "p Q Go � fA LU An co z > co 0 CD Oc cmcCD f ~}' to cc Z O �y y e �� f V� i2l" CO ;g m L a, �O y CD CL. CL cm< m ..� y C O O �.a.0o c f `' = M Q 4 Cd CO cm" co air,�,! C Z co z CL C.31 q Z c ''� j V y -'- `a o vs '0� p_a• cc C 7 Q m y m c o Z o :03CL 0- - $:w OAF— ._ W WC U.10 Com: fl. cmQ ruj CD OOoe HERITAGE AT NORTH ANDOVER CBT # 93736.00 BUILDING DATA SUMARY (MARCH 1994) USE GROUP R2 Multi Family CONSTRUCTION CLASSIFICATION 5A (protected) FIRE RESISTIVE RATINGS (Mass. Code Table 40 1) Exterior Walls 1 Hr. Fire Separation Assemblies 1 1/2 Hrs (Table 902) Smoke Barriers 1 Hr. Exits, Exit Hallways, Stairways 2 Hrs. Shafts and Elevator Hoistways 2 Hrs. Exit Access Corridors 1 Hr. (1/2 Hr. if sprinklered) Separation of Tenant Spaces 1 Hr. Separation of Dwelling Units 1 Hr. (1/2 Hr. if sprinklered) Interior Bearing Walls, Columns 1 Hr. Girders, Trusses Floor Construction 1 Hr. Roof Construction 1 Hr. GENERAL STATISTICS A. Number of Stories 3 Stories Max 40' Height B . Square Footage West Wine 1st Floor 11,807.0 SF 2nd Floor 9,420.5 SF 3rd Floor 10,021.3 SF East Wing 1st Floor 10, 251.2 SF 2nd Floor 10,021.3 SF 3rd Floor 10,021.3 SF 0 0 Total Square Footage 61,542.8 SF C. Unit Count West Wing East Wing Studios 26 31 > One Bedrooms 18 20 One Bedroom & Dens 2 3 46 54 Total Building 100 Units D. Allowable Area/Floor 20,400 S F E..' Total Occupant Load 427 F. Means of Egress Maximum length of exist access travel = 250' Egress width per occupant = 26.8" min. stairways; 20.1" min. doors, ramps, and corridors. Number of exits = 2 Min. Widths Stairways = 44" Corridor = 44" at ground floor A wing, all others = 36" Doors = 34" clear opening to meet access board requirements. 015.007/93736.00 r HERITAGE AT NORTH ANDOVER ADS/NDNE CBT # 93736.00 CODE REVIEW ` v (MARCH 1994) Article 1 Administration and Enforcement 120.0 Posting Structures 120.02 Posted occupancy load: placards are required in all rooms (where practicable) of dormitory buildings indicating the maximum occupant load. 120.03 Signage must be furnished by the Owner, be of permanent design, and if lost, shall be replaced immediately. 12.01 Violation 121.4 Violation penalties: punishment by A FINE OF $1,000 a day and one year in jail for each day the violation continues. Article 3 Use Group Classification 309.0 Use Group R. Residential Uses 309.3.1 Multi family = use group R-2 313.0 Mixed Use and Occupancy 313.1.4 Incidental uses: if supplemental to main use and not more than 10% of the area of any floor or 10% of allowable area; fire separation not required. Required type of construction based on main use of building. Article 4 Types of Construction Clarification 401.0 Construction Classification Table 401: (Type 5A = protected) 1. Exterior walls = 1 hr. 2. Fire wall and party walls = 2 hr. 3. Fire separation assemblies = 1 1/2 hr. 4. Smoke barriers = 1 hr. 5. Exits, exit hallways and stairways = 2 hr. 6. Shafts and elevator hoistways = 2 hr. 7. Exist access corridors = 1 hr (1/2 hr if sprinklered) S. Separations: Tenant spaces = 1 hr. Dwelling units =1 hr (1/2 hr if sprinklered and also corridor walls) Other non-bearing partition = 1 hr. 9. Interior bearing walls, bearing partition, columns, girders, trusses =1 hr. Heritage at North Andover Code Review March 1994 Page 2 10. Structural member supporting wall = 1 hr. 11. Floor construction, including beams =1 hr. 12. Roof construction, including beams, trusses, framings, arches and roof deck = 1 hr. (fire retardant treated wood permitted) 401.4.1 Roofs, floors and walls: combustible elements permitted. 1. Interior finish and trim (922.0, 923.0 and 924.0) 2. Light -transmitting plastics (Articles 20, 21, 22 and 23) 3. Fire retardant treated wood (903.0) - 5. Roof materials (2301.0) 6. Thermal and sound insulation (908.4, 928.0, 1709.4, 2002.0 and 2301.4) 7. Exterior veneer and trim (926.2 and 2105.0) 8. Nailing or furring strips (900.3.1 and 923.0.9) 9. Windows and doors (907.4) 11. Partitions (905.3) 12. Roof structures (927.0) 404.0 Type 5A Construction 404.1 General: Buildings and structures of Type 3 construction are those constructed of masonry or other approved non-combustible materials of the required fire resistance rating and structural properties; the interior framing, floors and roofs are wholly or partly of wood, metal, or other approved construction; fire and party walls are ground supported; and all structural elements shall have the required fire resistance rating specified in Table 401. Article 5 General Building Limitations 501.0 General Area and Height Limitations Table 501: Type 5A construction, Use Group R-2 = 3 stories, 40 feet in height, 10,200 S.F./floor. 501.4 Multi -story buildings: percent reduction of area limits (Table 501.4) = 20% for 3 story building of Type 5A construction (10,200 x 80% = 8,160). Area Limitation = 8,160 S.F./floor 502.0 Area Modification 502.2 Street frontage increase: 2% x 75% = 150% increase in area. 8,160 S.F./floor x 150% = 12,240 S.F./floor. Heritage at North Andover Code Review March 1994 Page 3 502.3 Automatic fire suppression system: 100% increase allowed for buildings more than 2 stories in height. 8,160 S.F./floor x 100% = 8,160 + street frontage increase = 12.240 20,400 Allowable area = 20,400 S.F./floor 503.0 Height Modifications 503.1 Automatic fire suppression systems: if building is fully sprinklered an increase of one story and 20 feet is not allowed for 5A buildings. N. Andover zoning governs at 40' max. height at peak of roof as per R5 sub note 7d. 505.0 Existing Buildings 505.1.1 Minor changes: Changes, alterations or repairs to the interior of a building or to the front facing a street or other public space shall be permitted, provided such changes, in the opinion of the building official, do no increase the size or the fire hazard of the building, or endanger the public safety, and are not specifically prohibited by this code. 505.2 Increase in height and area: It shall be unlawful to increase the height or area of an existing building or structure, unless the building or structure is of a type of construction permitted for new buildings or structures of the increased height and area as regulated by Section 501.0 and in conformance with Section 106.0. 512.0 Accessibility for the Physically Handicapped 512.1 Accessibility is required: at least one primary entrance; entrance accessible to level where elevator available in building. Where ramps used; slope not greater than 1:12. Article 7 Interior Environmental Requirements 702.0 Existing Buildings 702.1 Unsafe conditions: In all existing room or spaces in which the provisions for light and ventilation do not meet the requirements of this article and which, in the opinion of the building official, are dangerous to the health and safety of the occupants, the building official shall order the required repairs or installations to render the building or structure livable for the posted use and occupant load. r Location f No. ,'' Y Date cz. TOWN OF NORTH ANDOVER Sewer Connection Fee $ Water Connection Fee $ TOTAL $ uilding Inspector 7713 Div. Public Works v n , Certificate of Occupancy $ + # Building/Frame Permit Fee $ ^^°' Ech s�cH Foundation Permit Fee $ _ 166r Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ uilding Inspector 7713 Div. Public Works v n PERMIT NO. 5 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 I MAP 440. LOT NO. I 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE SUB DIV. LOT NO. — j�CATIONOQ CI�i� Roilltl7� /tl /1'- bout , r/� POSE OF BUILDING © JAY OWNER'S NAME C�� �) r` S j� —.i 1 0 / ` NO. OF STORIES SIZE _ OWNER'S ADDRESS /v~ �� e BASEMENT OR SLAB ARCHITECT'S NAME -- SIZE OF FLOOR TIMBERS IST 2ND 3RD j4JJ'YLDER'S NAME (A. gi_ /1, 1 1,� Q le SPAN I DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET 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 IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR "` DATE FILED S h� to SIGNATURE O W R O UTHORIZED AGENT FEE PPERMIT GRANTED /// 19_ -7 -�,3 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY OWNER TEL. # CONTR. TEL. N CONTR. LIC. # H.I.C. N INSPECTOR 1 OCCUPANCY SINGLE FAMILY STORIES MULTI. FAMILY OFFICES _ APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M TAREA _ 1/1 1/2 '/. FIN. ATTIC AREA _ N_O BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WAILS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING I II ADEQUATE I I NONE 1 5 ROOF 10 PLUMBING GABLE HIP GAMBREL MANSARD FLAT I SHED BATH (3 FIX.) _ FORCED HOT AIR FURN. TOILET RM. 12 FIX.) WATER CLOSET _ ASPHALT SHINGLES STEAM LAVATORY _ _ WOOD SHINGES HOT W'T'R OR VAPOR KITCHEN SINK _ SLATE AIR CONDITIONING NO PLUMBING _ TAR R GRAVFL STALL SHOWER 6 FRAMING I 11 HEATING WOOD JOIST PIPE LESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING I UNIT HEATERS 7 NO. 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W H M u C� .O MM� L O v Z co Q O y � C � CD c CO) p M E co �E m m CO CO CL co O � O > Co co L R O Q CL CMQ CA o Cc CJ J� co) ZO co 0 CL V y O C C C COD z 0 Q Cr LU cn z C) U c L C L L C Ev V O FM4 •mw.. o a� c C v o CCc C=G »•- 0 2 O � • -•: f E Q V �. O r0+ H • 1� c = O = o0 Q: is s cm d i.+ N t' H y co 3 v C1 Occ J (n C c = C cc N CD .j o C Q p�Ct �vyZ It CL. Q m H m C m ®L 3 :d ++ O h sR m m Nd O 4:e C w rr H M = � O C �CD om a COD a m '� _ cp co H •O s $ c.�m 8 o F. O U iW :r -W Cn z c� ;z A cm Gf� rn r� i J n �J U J • LJ co .O E O i � o o � Z o Q O y D � I � y 0.— LA y m m .CDo w CL ~_ Co O i Co Cm CD L tC O a a- o� Q yCcC aL•+ C VCL CD J •C O .co Z cj V 0 CLy C ca d E J Q z LL z 0 crQ W U) z 0 U Cd a iJ 0 O 0 U E-+ O w � c � �' U � x z z z ,"W4 W P -W z a A z u z A o U a O m e a w v z Y O 0. G 7 m O C ' m O G W � is O 6. u ;G. a O O " y 0 7 u w cn w U w O FM4 •mw.. o a� c C v o CCc C=G »•- 0 2 O � • -•: f E Q V �. O r0+ H • 1� c = O = o0 Q: is s cm d i.+ N t' H y co 3 v C1 Occ J (n C c = C cc N CD .j o C Q p�Ct �vyZ It CL. Q m H m C m ®L 3 :d ++ O h sR m m Nd O 4:e C w rr H M = � O C �CD om a COD a m '� _ cp co H •O s $ c.�m 8 o F. O U iW :r -W Cn z c� ;z A cm Gf� rn r� i J n �J U J • LJ co .O E O i � o o � Z o Q O y D � I � y 0.— LA y m m .CDo w CL ~_ Co O i Co Cm CD L tC O a a- o� Q yCcC aL•+ C VCL CD J •C O .co Z cj V 0 CLy C ca d E J Q z LL z 0 crQ W U) z 0 U 4j b 41 R Av �I O FMM4 o as c C) c � QU o � C H O = R o :a= ccco :L o n p � I: y Q :. E V Pd o t O O a ca, Q� �•' Q' h' c o 3 ca • doo: m C O' yy �+ CO) CO) J" co rn C a •_ • •i % m L C E W i CLU Q :ago H m d • - -Co. O Q a,c� m c CCe z m C3 w �o a a m = m :moo CL LLC �• •col •O.L R o= •E c)cm v �' y d o'fl O C Z R � � y •p s $ o. m CD y H :O O i h C 0 Cm o o) C m cm0 •C N m L O Z 0 J 0 5 :a :O :U :W Cn z :z A Cll Gam' ►: n `.J U r U U r -•-i z O .O E 0 i 0 o C) Z CD CL O y � C CO co— N W W .GOO co CL ~_ — *-# co CC >. O i Co CD cc O a CL g=Q H tC O co co 0 CL C — d is J Q Z Z O Q Cr W U) Z 0 U J Q Z i ..i A C v CA X I- o o -czW W u � w v � � ri U) r. U° C4 U i a�' w Cn a�' x W Cn C/� Av �I O FMM4 o as c C) c � QU o � C H O = R o :a= ccco :L o n p � I: y Q :. E V Pd o t O O a ca, Q� �•' Q' h' c o 3 ca • doo: m C O' yy �+ CO) CO) J" co rn C a •_ • •i % m L C E W i CLU Q :ago H m d • - -Co. O Q a,c� m c CCe z m C3 w �o a a m = m :moo CL LLC �• •col •O.L R o= •E c)cm v �' y d o'fl O C Z R � � y •p s $ o. m CD y H :O O i h C 0 Cm o o) C m cm0 •C N m L O Z 0 J 0 5 :a :O :U :W Cn z :z A Cll Gam' ►: n `.J U r U U r -•-i z O .O E 0 i 0 o C) Z CD CL O y � C CO co— N W W .GOO co CL ~_ — *-# co CC >. O i Co CD cc O a CL g=Q H tC O co co 0 CL C — d is J Q Z Z O Q Cr W U) Z 0 U J Q Z i I o O F=14 I� cz A� 0 �- MEW 'Ifz W �h II _ C • JJJ\ Vi - z . LLI 0am o m c c 0 C c ` O N 0 a= W R MCL, c cc 0 L • W/ • �: : 02 s E C. O L •Q:O O c3.. JJ 0: s cm C O oc O a O N O • �: O'`a-1 5 CL N ?11: COD� r.(D (•i� L Q � a-3 ` • N m m O CA c Q vN Z ev r- 0 ao QCWJ mc COD r cc m �... m W _ •_.. t m = •E Ci no WE N CC d O'a O c :a o I --s aO m O tro ti J Q Z z C) Q W Cl) z 0 U J Q z EZ O E� O U U Ui �O W x z z z z Q z z G a v a u Q G v m a' �•'� U U W a p w o cc V)a o O O O G p G —cz W p y G to p G j w cn w 0x U w rx w r� cn w u: w' c0 cn cn Vi - z . LLI 0am o m c c 0 C c ` O N 0 a= W R MCL, c cc 0 L • W/ • �: : 02 s E C. O L •Q:O O c3.. JJ 0: s cm C O oc O a O N O • �: O'`a-1 5 CL N ?11: COD� r.(D (•i� L Q � a-3 ` • N m m O CA c Q vN Z ev r- 0 ao QCWJ mc COD r cc m �... m W _ •_.. t m = •E Ci no WE N CC d O'a O c :a o I --s aO m O tro ti J Q Z z C) Q W Cl) z 0 U J Q z EZ Q T - r 0 F=04 ot uj om 3 =� 0 CL) c c � : o � c ` / O N :M 0 r coo i O O • ♦• O O -AA 0 P o CL r.. N o= ^ O O • is L7 y,� n «. N R • �: o o ya`73 a S = c N p d� := arE ca Q is y:, i m . 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C3 �Lz'o s ii •,'1F' C O Q C C t �vyz C a m ya o c m :m=3 a H O p H C#* r... cc W ~ •N O CR w.+ U= 'E 5 � v " U= o oom c COD a o 32 = eNa a'`Ha s ,$a. -m as CL N N .p 0 N Of m cm m `o CM c c 0 N CD L O Z O O ►ra z O z C/) h - w a4 L] co -O E 0 i 0 o Z co CL O y o c ICO CM � C N co VA O ' O •E co CL �+ .00 O i Co O O m 00. CL �a o Cc .v J -p C� Z CO CL C-7 CO) cc c C _cc �. J Q Z LL E4tll LZ 04 0 O 0 F-4 u Ul E4tll LZ Cl) CD CA m C, C U r eo =Co 'A co CL E S ca 0 Co CO3 0- .0. cm di CCO) C &O :t-- �- (A (A Co cc =ca - =0 'a m ca E co 0 CM 0 � mo� �oyZ C, cci)) 'a CL— C CA) C_•+ •m ca MD CL.= M E B -c Ll S2 c4) ID b- C3 s 03 cm 0. CL ID. -0 0 5 = co cc m OM= m 04 0 0 F-4 u Ul U w z z z z u u F` a OC Z r 6 a z V) V M cz --a CU -a E —cz U 0 0. r- 0 C: 0 a C: 0 (U V) u �c 0� V) w w cc V) V) Cl) CD CA m C, C U r eo =Co 'A co CL E S ca 0 Co CO3 0- .0. cm di CCO) C &O :t-- �- (A (A Co cc =ca - =0 'a m ca E co 0 CM 0 � mo� �oyZ C, cci)) 'a CL— C CA) C_•+ •m ca MD CL.= M E B -c Ll S2 c4) ID b- C3 s 03 cm 0. CL ID. -0 0 5 = co cc m OM= m co .0 E 0 O O 0 CD Z CL 0 CO) CD cm CO) CD CL) W co co CL co O :m. co co C.) cc CL CO) C.) 10 •co CO2 CD 0 CL cc 'a LO m m o U z r .ter N r f) �z co .0 E 0 O O 0 CD Z CL 0 CO) CD cm CO) CD CL) W co co CL co O :m. co co C.) cc CL CO) C.) 10 •co CO2 CD 0 CL cc 'a LO m m B 0 H � !R L—* )911- FAAM : .:.Ss co c c C.3 o Cc L) C.3 -a -oc CL R c .0 Cc nn C* is 49� co j— ca „ cz co Co \, cm coP ca m co •0: co CL C2 CO) CO) CL) CO) CA: f= Z co .0 ca cc A'— 0 N 0 E m cm X: co 0 i CLU i G3 43 C52 4=2 43 C3 :7A 0 43 5 Z 0 7 :coo cm CL ca z 2 ': L. =CD CD 2 . C=O 0 ri s . CD CD coo L—U uj M fV EcD cA CO LU cm • C.3 HQ CL zip CD U) cc 0 b- :a CD CL..- Cc o O u wy O w P-1 r -W r_w 9) t a) z 0 z z P -W P-4 0cn z <� u z ao C: 0 -4 0 CQ 0-4 L Cf, z 05: E 0 �E C: oG W 0 cz G p GE u V. V) LZ C4 u w cG w u C4 V) FAAM : .:.Ss co c c C.3 o Cc L) C.3 -a -oc CL R c .0 Cc nn C* is 49� co j— ca „ cz co Co \, cm coP ca m co •0: co CL C2 CO) CO) CL) CO) CA: f= Z co .0 ca cc A'— 0 N 0 E m cm X: co 0 i CLU i G3 43 C52 4=2 43 C3 :7A 0 43 5 Z 0 7 :coo cm CL ca z 2 ': L. =CD CD 2 . C=O 0 ri s . CD CD coo L—U uj M fV EcD cA CO LU cm • C.3 HQ CL zip CD U) cc 0 b- :a CD CL..- Cc o Cf), L Cf, D 7' rn �zzs U 0 4% /A-,% 00'.6 SIG 0 •arc 9 0 v GG u w w1 x w x A z z z z z w z ° w. = �� w ¢ Q w w z o w cn to 0 _C C w a U w a U—cz C u: w a w a � p v C cn w m 0 C 04 w v v v o 7 E W cn cn 4% /A-,% 00'.6 CD Y" V: `AGO �� O • �; V .o.. di C a a::. E CO2CL) CL cco 0 L H c y 'co 0 3 +- O Q� I O y �J � p�� y L = : �y+ H cm mCLU L� -L y m ; cr- , 'OCA C cm m � 0 Q'voo L Ci V•�Z O \ C13 o .� cm •� coo c a a 4D 3 o m a N H y 01-- m � :/i ev s m �� �-- LL .y oa�c o H y �at Z 0 . �• �. umi.9 n =O.fl o C m 'fl f 0 y _ � L " .� c z $ aim M, SIG 0 •arc :tea W c Cn o � z C H o c� w. = O A CL CL :C I) CD Y" V: `AGO �� O • �; V .o.. di C a a::. E CO2CL) CL cco 0 L H c y 'co 0 3 +- O Q� I O y �J � p�� y L = : �y+ H cm mCLU L� -L y m ; cr- , 'OCA C cm m � 0 Q'voo L Ci V•�Z O \ C13 o .� cm •� coo c a a 4D 3 o m a N H y 01-- m � :/i ev s m �� �-- LL .y oa�c o H y �at Z 0 . �• �. umi.9 n =O.fl o C m 'fl f 0 y _ � L " .� c z $ aim M, .O E co 0 o COZ CL O CO) C C co cm CACO VA co O �E mco 0 CO m CL H _ ..+ co O i Co O i !OC O Q �Q cn = O � R CO.) J -0 •Q O CO C Z co V y C COD cv C fl. D J Q z Z O `Q m LU Z O U 0 W Cn z c� A O U n� z U VJ Cn W � O .O E co 0 o COZ CL O CO) C C co cm CACO VA co O �E mco 0 CO m CL H _ ..+ co O i Co O i !OC O Q �Q cn = O � R CO.) J -0 •Q O CO C Z co V y C COD cv C fl. D J Q z Z O `Q m LU Z O U M Q M r. cd 1.0 W •: c �- o a� c := o c O H vO V d= dC O A O C cc :t G o CL 0 o c° 4 o • 0 O F=4 O� rf�c p T• a� C � ,�yy,, N yCD 3 (nU C O J Y ' m _ C N cc CL hCLI O CA C Q v yZ c ao y CD m 43 3 CL _ o COD `. R m$ m uiCDLAJ m rr CLLU •E v -0 c3 vi m om== COD Z C43Go •O. H •0 P_ .c $ a � m co CL CO) s yr N O N 0 co a m O! 0 cm C N m s O Z 0 g O WA M v �U w co •E CD CL CD C O CO 0 m r�7 O V CV CL CO) C �1 IN r�mml z O Q Cr LL1 C) z O U C L C c L C I O 0 0� U F+ W U (n U w � x Q z z z z W �Awur E O z G paaCla i w avvG CG '10V) a ° CC� C e wois wpvGUv m C ° v oE w V) . 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COD V C _c d CO2 z 0 Q 5 LU U) z O U f A�. W Jy 5: U p w w w w A ° U as C/) GG w w z .L Ma r iC m W iC G O v O 7 O .G G G O G p G G w cn w U w u: w cn w rx w as cn cn E2 O F=4 p z . n-. C O CO C c s o � L O N • o. c o c = O O L • ♦• O O CJ n CA O O 0 hts Cp 0 a . �Wca m 0• L L C a, N H �+ 3 i/ O J c •O � �•:.m = c N R Eco 00N L 'C H V L . m m o 'r CM o c C Q nes vyZ O n Q i C O C ncFo- VO W O •fl '� C rte.+ r •N C22 -:5O C oc �Ec,-0 Cc, N y CL o� of = C42marca H t ZZ O. r=-. m m CLN O N C 0 os m C" c Co O cm c_ �C O N m t O Z 0 O WA O CO .O E co i � O O CO Z d O ti � C � co c CO2 co 'g CL) m CLCD 0 co ~ +=�+ co O i co coCL3 L- i CC O Q CL tmQ c -a o v EL CD C Z co /0 O. COD V C _c d CO2 z 0 Q 5 LU U) z O U a *_V. 089 �. W cz y x 04 �' w a4 N R\ z x z w o A z c� z u z A a v o U ca �n 7)u oa A a v Em o a U w r. w ii a w o cn ii co o w' w o (U w Wv n LE zc(: C") QO i4 1 O H � c o aS c c c L O H 0 n O L H Q L a o= ' O O di: O rl cDstm a.Ec E •CL o 3CO2m 03 s y H J" co3 pop— =m-=o •.LC N y �ca C ; O ,�? E C4 `a as CD's cm CD Q -' t t o os CMC) p Q momca V H O O ,Z cm C3 E Q C H m= O LLI c0 U__ 'VI O.Z p C Z ac 'E v - ; h O LU co o m c a C4a. = eyv n Ce p LCL co .O E � o o C.3 coZ fl. O y O C � c cmco_ y 0 � W O �O .g m m co 0 CO co O i Co coCL m L CC O Q �Q CO) c� O Ca C) .c ZU ca o O Q C ' C R CO) Q Z LL z 0 Q LU z O U :C� O :U :w z :z A ^J r r 2 ` T U � J ., e O r� � U f -..i w U � r --i � o co .O E � o o C.3 coZ fl. O y O C � c cmco_ y 0 � W O �O .g m m co 0 CO co O i Co coCL m L CC O Q �Q CO) c� O Ca C) .c ZU ca o O Q C ' C R CO) Q Z LL z 0 Q LU z O U 0 tai I. 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CD .0 Z CLI) V V2 O C C CO2 J Q z Z O Q 5 LU z O U CD Z z Z O w z C7 z A 1 v O U r ^' r vi w U C14 W Z -a U O co .O E d i � o O C3 Z co CL O CO) CO D � I =c V3 'C CD L* co C m .c m clo o cm co O i Co OCm i cc O Q CL ora C .o o cCv C..) CD .0 Z CLI) V V2 O C C CO2 J Q z Z O Q 5 LU z O U CD Z z Z O H J o NO 74 74 v U O z O Q LU Cl) z 0 U J Q z 0 U O •UV O wQ w c U) x zz Cl)o x wO H� d � mcov o L• = ct -i L C. = r-:) w L _ ►� z v r 1 a LL (n O -� LL. P� U C.L G C LL C4 cn LL x L%C"J (n O H J o NO 74 74 v U O z O Q LU Cl) z 0 U J Q z lal O F=04 a o o� x HO z z a p w A z oil u w a v E d h A W C o c E, A W Z � o a u° cn c c wo 0o U w a `° rxo w W a m ao' cn w a w a o rA m c� O F=04 CLL - co H y ;o 0 co) C CD m m cm c 32 m 0 rn c N co Z w O Z O g O VZ O co .O Co L O O v Z CO CL O H co C C CO2 ME co LA O .O �E m m CO co L O � O i Co O i O d ca = 'C o Cc CJ .J 'O CL CD CO2Z 0 CL V en O O — C. 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V)c° r� U u, cG iL u: cn w cG iz. cG cn s <�J YA �o o � L O N v CD •dam C H �cc � o L d • .� cc O L 0 goo: L o } CY o c 7 - �� E o o o O t5 a� O r1Wc 0 3�cv 0 C O• L L �+ N N C C � 02 �• N = N •� E o.v N C ' L 0� CD •, L L O Qf� C • � C O Q N m�O � oyZ • eo :C.. .� c F-� m N a0 m C Q m mr3 S : CL +. O h a.. O m m W O fl r CA •y m A A C N CL O 4- CO W .E t7 •o C1 Of C.3 m oC c COD O. m•� O S cc y •O F•- z a.- CO E CD CL _N L N .0 O N C C) 6D Cf C CG 0 cm C .0 0 N O Z O O A .O E ai 0 o Z d O y � C Co O .0 CD y � � N CD m m CD o CD CL ~_ +=-� CLI cG � Q > oCDL Cc O d CL Q cn O C 'Q o C33 cn C CD 0 CL U H C O .0 C _c d J Q z_ L.L Oct. -ACL Wv,APT m0m CERTIFICATE OF USE & OCCUPANCY Town of North Andover TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES AUGUST 31, 1995 Building Permit Number 446 (1994 ) Date July 14, 1995 (Model Lobby 122 & 125) (Model Apartment Units - W101, W102, W103,W104, W105, W106, W107) THIS CERTIFIES THAT THE BUILDING LOCATED ON 700 Chickering Road MAY BE OCCUPIED AS Model Apartment Units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO North Andover Living Limited Partnership s ADDRESS 700 Chickering Road ''=ACMuS� Building Inspector JUN 02 '95 02:55PM NDNE/CONE P.2 199 Wells Avenue Newton Centre, Massachusetts 02159 (617) 964-1533 (617) 527-1977 (facsimile) 0 rCrenshow Construction WN of New England GENERAL CONTRACTOR FINAL AFFIDAVIT Heritage @ N. Andover 700 Chickering Road N. Andover, MA 01845 To the bast of our knowledge, the construction of Units 101 through 107, Lobbies 122 and 125, and Corridor 121 has been completed in accordance with the plans and specifications and any applicable Massachusetts State Codes. Signed: It Daniel i6dler/- Construction Manager Sam Dettore, J . Vice President Subscribed and sworn to before me this ', oh day of .U-ne , 1995. STATE OF: MASSACHUSETTS COUNTY OF: MIDDLESEX i . Jean Keohane NOTARY PUBLIC My Commission Expires: flReO1iI ION SaCE'IRESS VARU 15, 002 CERTIFICATE OF Distribution to: 171 SUBSTANTIAL AOWNER CHITECT ❑ COMPLETION CONTRACTOR 11 ELD AIA DOCUMENT 0704 OTHER ❑ PROJECT: Heri.tage at North ArdNer Senior Housing ARCH I T E C T : C13T/gilds Batrran `I8edores Inc, (name, address)700 Chidgering Road North Arxbver, IA ARCHITECT'S PROJECT NUMBER: 93736.00 TO (Owner): CONTRACTOR: dYa d-aw Clonstrtacticn of New ]igland North And ver Assisted Living Limited CONTRACT FOR: Oral Ctnstnx tirn Paru)?17hip ADS Senior Bing 139 Iain Street CONTRACT DATE: Sc aYber 19, 1994 LQmbricip, IvA 02142-1118 DATE OF ISSUANCE: PROJECT OR DESIGNATED PORTION SHALL INCLUDE: ' `Nb hl ApartITErtt Lhits" n aTbered W101, W102, W103, W104, W105, W106, W107, " Model Idal y 12211, and -McClel Idi:y 125" of the west wing. The Work performed under this Contract has been reviewed and found to be substantially complete. The Date of Substantial Completion of the Project or portion thereof designated above is hereby established as which is also the date of commencement of applicable warranties required by the Contract Documents, except as stated below. DEFINITION OF DATE OF SUBSTANTIAL COMPLETION The Date of Substantial Completion of the Work or designated portion thereof is the Date certified by the Architect when construction is sufficiently complete, in accordance with the Contract Documents, so the Owner can occupy or utilize the Work or designated portion thereof for the use for which it is intended, as expressed in the Contract Documents. A list of items to be completed or corrected, prepared by the Contractor and verified and amended by the Architect, will be issued later. The failure to include any items on such list does not alter the responsibility of the Contractor to complete all vvorK In accordance with the Contract Documents. The date of commencement of warranties for items on the attached list will be the date of final payment unless otherwise agreed to in writing. CBI'/Qiilds Bertmm Tsedores Inc. May 31, 1995 ARCHITECT BY DATE The Contractor will complete or correct the Work on the list of items attached hereto within days from the above Date of Substantial Completion. Crat sbaw CinstrLrtion of New F7gland Lu dted Partz—e ip CONTRACTOR BY DAT The Owner accepts the Work or designated portion thereoXsub, tially mple e and will assume full possession thereof at (time) on (date). North Andover Assisted Living Limited Partnership OWNER BY DATE The responsibilities of the Owner and the Contractor for security, maintenance, heat, utilities, damage to the Work and insurance shall be as follows: (Note—Owner's and Contractor's legal and insurance counsel should determine and review insurance requirements and coverage; Contractor shall secure consent of surety company, it any.) 'Il -e Owner shall take over all se=ty, mairtienanm, heat, cooling, utilities, cbm ge, and cleaning as of June 4, 1995. AIA DOCUMENT G704 • CERTIFICATE OF SUBSTANTIAL COMPLETION • APRIL 1978 EDITION • AIA@ 0 1978 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D C. 20006 G704 — 1978 E NOw TH OFFICESA,OF: o TO W I1 of nI>PE:ALs NORTH ANDOVER 1il1IUNNG •;,s4;..c .49 CONSERVATION CNVBE DIVISION OI: I-ICAI: rI-1 PLANNING PLANNING & COMMUNITY DEVELOIINIEN'I' KAREN H.P. NELSON, [AREC OR STRUCTURAL t. CERTIFICATE OF ENGINEERING BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 GENTLEMEN: 17 THOMAS RONA I -,ON :iiiI Shuc( No Irl I i Ai is k wc•.r, tili 10 tt iscws t) 18, (617)(i}i 1477 i . HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSEi"TTS STATE STRUCTURAL BUILDING CODE, FOR THE "MODEL APARTMENT UNITS" NUMBERED W101, W102, W103, W104, W105111 W106, W107, "MODEL LOBBY 122", AND "MODEL LOBBY 125" OF THE WEST WING. AUTHORIZED SIGNATURE: DATE: REGISTRATION STAMP: Of 00." OFr-ICE:S OF: ;�'' � Town Of - APPEALS . n 1 .: NORTH ANDOVER BUll-DING ;' 9 CONSERVATION *�CHUG DIVISION ()F HEALTH PLANNING PLANNING & COIVIMUNI"I'Y UL'VELOPMEN'1' KAIZEN fi.P. NELSON, DIRECTOR CERTIFICATE OF ARCHITECTURE BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET - NORTH ANDOVER, MA 01845 GENTLEMEN: I3O NI; iiiI Slrc•c•I Nc>rlIi AixImvr, NI; iss;1cli( .sc'll5(1lfi-� (6 17) 685 4 77 i I, MAURICE F. CHILDS , HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTTS STATE BUILDING CODE, FOR THE "MODEL APARTMENT UNITS" NUMBERED W101, W102, W103, W104, W105,, W106, W107, "MODEL LOBBY -122", AND "MODEBBY 125" -OF THE WEST WING. AUTHORIZED SIGNATURE: DATE: 5/31/95 REGISTRATION STAMP: No. 2067 OF ~NOH fH , '�... Town Of UFI=ICEF+OF: n APPEALS NORTH ANDOVER ss+GNU00` I) I V I S I O N OF CONSTRVA"I�IUN HEAL; fl -1 PLANNING PLANNING & CONIMUNI'I'Y UL'VELOPMGN'I' KAREN H.P. NELSON, DIRECTOR MECHANICAL AND PLUMBING CERTIFICATE OF ENGINEERING BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 1e1pklv11 ltWvt 1f I, JOHN PANITSAS 12ONl.iii) tilrc.(,I No lilt ) A))(IO\'c•r. (() 1 /) G85) ) A lt/ / 5 . HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTTS STATE NIDAL AMID FUMMG BUILDING CODE, FOR THE "MODEL APARTMENT UNITS" NUMBERED W101, W102, W103, W104, W105, W106, W107, "MODEL LOBBY 122", AND "MODEL LOBBY 125" OF THE WEST WING. AUTHORIZED SIGNATURE: DATE: REGISTRATION STAMP: Url-1 iOOF:-,~•~ 'Town of A171'e S :. _ . -f -� NORTH ANDOVEll BUIL CON! V,A,'l'ION DIVISION Of- runt PLAT 4c PLANNING & CONIMUNH'Y DEVULOPAIEN'1' KAREN H.P. NELSON, 01RE-0-1.011 ELECTRICAL CERTIFICATE OF ENGINEERING I LDING INSPECTOR I N OF NORTH ANDOV�R. MAIN STREET r TH ANDOVER, MA 81845 1210 A1;hiit ;ars Ni n'tt l Anc 1<)-•ra, %til��ik'111T�( Il5 ()184 i C TLEMEN: . I VINCENT A. DiIORIO , HEREBY CERTIFY THAT THE E LDING CONSTRUCTED! AT 700 CHICKERING ROAD IN NORTH ANDOVER, MASSACHUSETTS C S CONFORM IN ALL IRESPECTS TO TILE MASSACIIUSEI"TTS STALE ELECTRICAL: B LDING CODE, FOR "10DEL APARTMENT MTS" NUMBERED W101, W102, W103, W104, W W106, W107, "MODEL!LOBBY 122", AND "MODEL LOBBY 125" OF THE WEST !NTNG. A WRIZED SIGNATURE!: DATE11 .: XISTRATION STAMPI, '7_ 4z_ % 4 TOTAL P.02 JUN - 7 LETTER OF TRANSMITTAL Childs Bertman Tseckares Inc. 306 Dartmouth Street, Boston, MA 02116-2201 Telephone 617-262-4354 Facsimile 617-236-0378 Architecture Interior Design Facilities Planning Urban Design Date: 6-6-95 Attn: _SAM DETTORE From: SCOTT BOOTH CCNE _ Job Name: HERITAGE @ N. ANDOVER 199 WELLS AVENUE Job Number. 93736.00 NEWTON CENTRE, MA Reference: Model Units Punchlist The following items are attached: No. Date Description 1 6-1-95 Model Units Punchlist - Units W101 - W107 & Lobbies W122 & W125 - ❑ For approval 0 For your use ❑ As requested ❑ Review for comments = ❑ Please call,with any questions. Childs Bertman Tseckares Inc. 306 Dartmouth Street, Boston., MA 02116-2201 Telephone 617-262-4354 - Facsimile 617-236-0378 Architecture Interior Design and Facilities Planning Urban Design MEMORANDUM TO: Sam Dettore, Dan Feidler, Ted Tye, and File FROM: Scott Booth DATE: June 1, 1995 RE: NORTH ANDOVER SENIOR HOUSING CBT No. 93736:00 Subject: Model Unit Punchlist - Units W101 - W107 & Lobbies W122 and W125 GENERAL COMMENTS Set up in the kitchen the refrigerator shelves. • Remove the warranty information on the equipment in the kitchen. • Remove all plastic protective coverings on the labeled door plaques. Fix all hot water faucet knobs so faucet turns on without having to turning knob almost 180 degree. • Remove the protective covering around the fire alarm detector on the ceiling. Paint Whalen grilles. • Change the Whalen thermostats to the appropriate model. • Provide rubber stops at the jamb for the sliding doors. • Replace or snip off the screws of the toilet paper holder that extend into the cabinet. The existing ones are dangerous when reaching into the cabinet. APARTMENT UNIT 101 • Paint around the fire sprinkler heads in the kitchen, living room, and bedroom. • Foyer hall closet is satisfactory. • Paint touch-up needed on marks at the bottom of the front door (about a foot and half up on the right hand side). • Living room and kitchen areas are satisfactory. • Remove the three carpet stain in the kitchen area. • Apply joint compound and paint touch-up around the toilet connections at the bathroom wall and base of the cabinets. • Clean the medicine cabinet mirror. • Reset the hot water control knob_ ; it does not turn on until it is set 3/4 away around. • Bedroom is satisfactory. • Screw down more securely the lock clasp on the right hand bedroom window that is adjacent to the bedroom closet. • Remove the F&E tools in the microwave kitchen cubbie. jiSry - 7 1905 0 Model Unit Punchlist June 1, 1995 Page 2 • Remove caulking on the front door (left hand side, upper most panel). • Remove spots on the front door. . APARTMENT UNIT 102 Paint around fire sprinkler heads in the ceiling. • Paint touch-up needed on the fingerprint marks on the front door. • Apply guards at the bottom of the sliding doors in the bathroom. ^=V Remove the three, blue carpet stains outside the bathroom. • Provide missing cover plates for the emergency call button in the bathroom. • Clean the black marks off the shower rod escutcheons. APARTMENT UNIT 103 Change the locking mechanism on the first window (to the left of the Whalen unit) in the living room; the lock is difficult to operate and works backwards to the other locks in this unit. • Patch and paint the damaged window trim at the bottom of the second window and to the right of the Whalen unit in the living room. Clean the sill. • Paint touch-up needed just above the door stop at the closet door wall. • Reset the hot water control knob; it does not turn on until it is set 3/4 around. • Clean the bathroom mirror. • Remove the carpet stains near the chest of drawers in the living room and vacuum F&E debris in unit. APARTMENT UNIT 104 • Fix the front hall closet door which does -not close properly. It is warped or out of square. • Revacuum F&E debris on floor. • Remove the orange stain in the carpet below the fire = sprinkler head in the living room. • Repaint the ceiling at the sprinkler head. • Remove the protective covering around the smoke alarm detector on the ceiling. • Fix the connections. in the back of the linen closet. • Paint touch-up needed on, the back of the top of the linen closet door. • Replace the linen closet door handle with a brass one, not plastic. • Remove the three spots on the floor in the bedroom between the bed and window. Jill — 7 1995 Model Unit Punchlist June 1, 1995 Page 3 APARTMENT UNIT 105 • • APARTMENT UNIT 106 • • APARTMENT UNIT 107 • Paint touch-up needed at the front entrance door jamb; remove the glue that is stuck on the jamb below the latch. Provide a door stop at the front entrance Repaint ceiling -around the fire sprinkler heads Remove the soiled spot from the second drawer (down from the kitchen area). Provide a door stop at the bedroom. Remove the nail popping through at the right of the shower stall (next to the towel hook). Clean the shower and the spots on the shower floor. Patch and repaint the wood sill of the center window in the octagon bedroom. Remove the protective covering around the smoke alarm detector on the ceiling. Paint touch-up needed around the light fixtures and fire sprinklers in the living room, and front entrance. Clean the debris from the kitchen drawers. Paint touch-up needed at the bedroom closet door to the right of the pull. Patch and repaint the damaged door. Remove the carpet stains to the left of the television outlet and about one foot off the wall in the bedroom. Fix the damaged shower enclosure (right above the shower head); the gel coat has a hole in it. Fix the GWB and paint touch-up needed at the head of the linen closet. Fix and paint touch-up needed on the drywall above the medicine cabinet. Paint around the water connection of toilet against the wall. Provide missing cover plates for the emergency call buttons in the bathroom. Patch and paint hole in drywall under the bathroom sink at the drain line through the wall. Retape and paint the exposed drywall screw (one foot above the floor) to the left of the front entrance door. About three feet up, next to the latch, repair and repaint the divot in the drywall. Paint the ceiling around the fire sprinkler heads, there are three spots total. _ Repair the base between the windows in the corner of the living room. Repair the damaged carpet between the television and duplex outlet in the same corner. Repair the bathroom door which does not close properly; it stops short of the jamb by one inch. Model Unit Punchlist June 1, 1995 Page 4 • " Repair the base plate that is sticking out from the wall at the column in the bathroom as required. • Remove the paint drippings in -the shower stall just to the left of the controls at the top corner. • Remove the stains, just behind the toilet, on the bathroom floor. _ LOBBY 122 • Paint touch-up needed at the top of the Double Door No. 05 going into Elevator Lobby 140. �g - • Clean carpet. • Repair the bent ceiling grid outside Unit 104 and two tiles over from Unit 103. • " Paint touch-up needed at the free-standing wall at the shelf area on the left and right hand columns looking in the window. • Paint touch-up needed or clean spot on the wall to the left of Unit 101, just below the wall sconce. LOBBY 125 Paint corner of the living room area next to the table (about six to eight inches wide and three feet high). • Clean the jamb going into Unit 106. • Paint touch-up needed around the damaged ceiling tiles and sprinkler head just outside Units 105 and 106. • Paint touch-up needed around the ceiling tiles (four tiles out from door of Unit 106). • Check and fix the exit sign going out to the stairway; it is loose. • Paint the coordinate plates on the double doors the same color as the door (i.e., not gray). • Paint touch-up needed at the door face of the little door at the top and in the corner; there is a mark left from the door stop. • Change the door coordinator device at the top of double door leading to Lobby 122. Bright brass finish does not match brushed brass finish of hardware on door. SB :lf 013.001.93736.001f 71995 Com\ P -t 0 O z o C w o � �+ c H � oc ., �L) �wt :•ate CL c CC ev m c C* �'- •-• E Q CF m o n c E. 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O F=04 o o � c ` O N I �_v .cam ac Ica r: O O EQ C V �• �: �1 CD 7 'P E c O L O O 0 LJcm : 4 h o c r -L = O: �: CO) m • a) a N co • H �a`�3 Y • o �: H C R h m m ..tzz c ca c Q v y Z o � fl. Q m m C = m O.~" G y ;; A m — m W Cm = 'fl = LL •A •Q t O C c� m� LD m oms y C• m� O� _COJ i 0 E •_ CL N t H :O O N C 03 Of 63 cm c m 0 cm c_ •C O N CD t 0 z O O zoo z 0 z r� Cn :x o U :P.W Z m 0-4 U J U Cf) n n z O U Cil `MM•.i ^I rj J 0 co .O E CD i O O v Z CLC O y o = Ww, cm CO2 Q CD V� CD �E m m co co co O i Co � � L cC O O. E: =< ca E .o o �Cc CJ J -C O .0 Z cj O V CO) CO = Q z O `Q crw C/) z O V M To O H x U coo o a z C CG a4 cn z C LI, c w A ° 6J w V) ° .-C C w w U w 0 G w f% 1.4 u W .�. C w V) w L w G v w' cn ar, AFS. O F=04 o o � c ` O N I �_v .cam ac Ica r: O O EQ C V �• �: �1 CD 7 'P E c O L O O 0 LJcm : 4 h o c r -L = O: �: CO) m • a) a N co • H �a`�3 Y • o �: H C R h m m ..tzz c ca c Q v y Z o � fl. Q m m C = m O.~" G y ;; A m — m W Cm = 'fl = LL •A •Q t O C c� m� LD m oms y C• m� O� _COJ i 0 E •_ CL N t H :O O N C 03 Of 63 cm c m 0 cm c_ •C O N CD t 0 z O O zoo z 0 z r� Cn :x o U :P.W Z m 0-4 U J U Cf) n n z O U Cil `MM•.i ^I rj J 0 co .O E CD i O O v Z CLC O y o = Ww, cm CO2 Q CD V� CD �E m m co co co O i Co � � L cC O O. E: =< ca E .o o �Cc CJ J -C O .0 Z cj O V CO) CO = Q z O `Q crw C/) z O V M To • LETTER OF TRANSMITTAL t Childs Bertman Tseckares Inc. 306 Dartmouth Street, Boston, MA 02116-2201 Telephone 617-262-4354 Facsimile 617-236-0378 Architecture Interior Design Facilities Planning Urban Design Date: 6-29-95 D1995 4 Attn: SAM DETTORE From: SCOTT BOOTH CCNE Job Name: HERITAGE @ N. ANDOVER 199 WELLS AVENUE Job Number. 93736.00 NEWTON CENTRE, MA Reference: Exterior Punchlist The following items are attached: No. Date Description 1 6-21-95 Exterior Punchlist (except for front Entry, Parlor and front of Mail Area) ❑ For approval ❑X For your use ❑ As requested ❑ Review for comments ❑ Please call with any questions. I Childs Bertman Tseckares Inc. 306Dartm.outb Street, Baston, MA 02116 -2201 Telephone 617-262-4354 Facsimile 617-236-0378 Architecture Interior Design and Facilities Planning Urban Design MEMORANDUM TO: CCNE, File FROM: Scott Booth DATE: June 21, 1995 RE: NORTH ANDOVER CBT No. 93736.00 Subject: Exterior Punchlist WEST WING South Side: SENIOR HOUSING Cork pieces from shipping packing need to be removed from the windows. General Note: Nail heads on trim boards and casings of windows are poorly set nor caulked, if at all. The nails should be set, puttied, reprimed and repainted. • Caulk seams between ends of clapboards at the 2nd and 3rd floors and repaint. • Replace the picket on the railing above the vestibule entry on the left side closest to the building itself, reprime and paint. It is badly mangled. • Railing at the same location needs to be repainted completely. • Nail heads at the annunciator panel need to be set, caulked, and repainted. Trim needs caulking at joints where it meets the clapboard • Clean clapboard just above the annunciator panel and repainted. Caulk the same clapboard where it meets the window. • Front entry at doors on hold until the work is completed • OSB trimboard at outermost corner of western dormer, to the left of the entry, is not flush where the seams meet. It needs to be sanded down, primed, and repainted. • At the interior corner, just outside the office and below the soffit, needs a clapboard that is coped around and under the soffit. • Caulking needed where the soffit meets the facia board just above the window outside the office. North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 2 Recessed Area Between East and West Dormer Western Main Dormer Front Facade with Turret Drip edge above the office on the low roof is mangled at the right hand corner it should be straightened out if possible or replaced. Drip edge on rake at the western corner is coming off right at the very corner where it turns to the soffit. • Railing at the flat roof needs to have another coat of paint. • Foundation formwork tie rods need to be broken off. • Last clapboard at the needs to receive another coat of paint. • Window sill on the first floor has paint that needs to be cleaned and removed. • Joint at soffit board at the corner needs to be caulked underneath. • Left hand corner boards at the second story where they butt together are not flush and needs to be sanded down and repainted. • Face of the main dormer is satisfactory. • Western face of the main dormer is satisfactory. • Fluorescent paint below the exit door needs to be removed. • Parging needs to be provided to the left of the stoop at the foundation wall on the concrete blocks that are exposed. • Window sill to the left of the exit door on the first floor is damaged. • A piece of the door is missing, Repair or replace. • Wood trim between two third story small windows is not flush with the bandboard running below. Sand, reprime, and repaint this area. • At first floor window of turret, the MDO panel between the window and corner is damaged. It needs to be patched, primed, and repainted North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 3 West Side: Western Facade with Turret North Side: Northern Facade below Deck Recessed Area between the Mechanical Room and Eastern Facade below Deck • At the turret, the wood shingles need another coat of paint at the first row. It looks as though the first coat was put on when it was raining. It is currently discolored • At the first floor double window on the casing to the right, there is a bracket attached to the trim, remove, patch hole, prime, and repaint. • Paint splattered below left hand single window. Touch up with clapboard paint. • Underside of railing at third floor on the end needs to be repainted. Repaint throughout the length of the railing. • Patch damaged portions of railing or replace, reprime, and repaint. • See note regarding deck railingto west above, regarding the underside of railing on the third floor and at the vertical posts need to be filled. • Balustrades are missing paint on some sides; need 2nd or 3rd coat to cover poor paint job. • Clean and remove paint splatter between wind- ows at the first floor just below the trim band. • Paint splattered on sill of first floor, right hand window. It needs to be cleaned and removed. • Back shingles need to be repainted. Numerous "holidays" at underside edge of shingles exist all over Paint exposed cedar. • See note regarding the third floor handrail. • Screens missing from the first floor windows and Lobby 122. • Paint splattered on window sills of Lobby 122. • Another coat of paint needed at the trim sill of window on Lobby 122. • Remove paint from face of the window sill on North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 4 2nd to 3rd Floor Area Above Mechanical Room Western Elevation at the Mechanical Room Mechanical Room Enclosure the same location. Also, clean the window. • Second coat of paint needed on the entire window sill. Set the nail heads, putty, and finish the job. • Remove the paint from the second floor window between windows. • Bandboard needs second coat of paint above fust floor windows, • Facia at third floor where it transitions to the sloped condition was cut too short by an inch. Somebody infilled between the facia and the return board with putty. Cut back facia by at least a foot on a bevel. Apply correct length of facia, prime, and repaint. • Edge of facia and soffit needs a second coat of paint; • Note for landscaper: Top soil or stone is missing from the area in behind here at the Gas Meter • Rear door to the mechanical room needs two coats of paint. • Nail popping just above door handle to the right; set, caulk, prime, and repaint. • Remove coat hangers and wire running off of Meter box. Properly dispose. • Corner of trim board just outside the receiving door is damaged and needs to be filled with putty, caulked, and repainted. • Side doors by the mechanical room and walls to the right of the door needs to be painted. • Fensed in mechanical area needs to be painted; primer coat only on the existing back wall. • Walls and trim need to be painted. Steel tubes needs to receive protective paint coat. • Interior of enclosure fence needs to be painted North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 5 Back of the Mechanical Enclosure at the Fence Area • The uppermost trim board on the eave needs a second coat of paint on the edge. There is an exposed plywood may delaminate. • Caulking needs to be provided where clapboards meet at outer corner board and interior corner where at the receiving area. • Back of freezer storage area is satisfactory. East Side of Refrigerator/Freezer Area • At soffit, back corner should receive caulking where it hits the facia. • Caulk at the outer corner, third clapboard down. • To the right of the refrigerator condensation pad, five clapboards down, the clapboard is damaged. Nails have not been caulked or puttied Fix and repaint the clapboard in that area. North Side East and West Dormer • Repaint the clapboard at the window to the kitchen, just below the facia. • Remove paint from the exterior of the window into the kitchen. Spray paint splattered all over both windows. • Caulk the nail heads. Prime and repaint the windows. • Set nail heads at vent louver between the two windows. Caulk, prime, and paint. • 2nd and 3rd floor work is satisfactory. Eastern Side of the Eastern Dormer, Next to the Dining Room Debris needs to be removed at the drip strip, ie. cardboard, paint tops, loose CMU units, dirt below the door. Western Wall of Main Buildi Above the -Dining Room. • Railing at third floor flat roof needs to be primed and painted. • Trim condensate line back at first floor between dining room and the exit stair. North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 6 Dining Room by Eastern Exit Door and Back Wall by Eastern Dining Room Exit Door by the Walkway North Side of the Center Portion of the Main Dormer • Dining Room railing around roof top unit needs to be completed, primed, and painted • Remove concrete splatter. It looks like from the middle window of bank of three next to exit stair. • Screen is missing from right-hand most window of that group. • Soffit around the dining room by the exit door needs to have a second coat of paint. • 2nd coat of paint needed on the window casing to the right of the door and corner boards. • Caulking needed at the exit door where trim meets clapboard on both sides. • Right hand window next to exit door needs to be repainted. • Tape needs to be removed from the exit door. • Exterior of door needs another coat of paint. • Note for Landscaper. Where the drip strip intersects the back walk off the exit door suggest raising the stone to cover the dirt below the edge. Confirm with Landscape Architect. • Caulking at frame on both sides needs a second coat of paint. • Patch trim board, just above the handle. • Second coat of paint needed on right hand window, soffit, and left hand window. • Back side of outer facia board to the left in the corner needs to be painted. There is an exposed area of clapboard. Same all the way along the back of the dining room area. • Some clapboard are missing caulking between the butt ends they need to be filled, primed, and repainted. • Between second floor windows at the band board, white dripping on the clapboard needs to be touched up with clapboard paint. North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 7 Eastern Side of Main Dormer at the Back Next to the Library Eastern Side of Eastern Dormer, above the Library Rear Elevation at the Library • Touch-up paint at the second floor left hand window just below the sill on the clapboard. • Touch up paint needed at the head of first floor window to the right. • Remove cork patches from window on the first floor. • Clean sill at the window on the first floor. • Sill trim board at windows just next to the door needs to be patched, reprimed, and repainted. Set nail holes, caulk, and repaint. Caulk gaps in trim by the door. • Caulk clapboard where it meets the trim of the door all the way around. • Set the other nail holes around the door trim. Prune and repaint facia of the casings. • Remove cork patches from the windows on the first floor. • Caulk nail holes to the left of the bank of three windows on the clapboard just below the facia. Prime and repaint. • Clean the facia in the fust floor area. There is excessive amounts of stained trim. North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 8 EAST WING West Side: Porch Elevation Second and Third Floor Above the Porch Western Elevation of the Two Dormer Area above the Community Room Elevations above the Door to the Community Room North Side: North Side of the Main Building Elevation above the Community Room • Set. nail holes on clapboardnext to door going into the porch. Caulk between the clapboard and trim. Set nails, prime, and repaint casing and door. • Caulk nail holes in the soffit just to the right of the door, prime and paint. • Satisfactory. • Remove cork patches from windows. • Fill cracks in the railing on the second floor, prime and repaint. • Four windows at the screen porch area, caulk the -nail heads, prime, and repaint. • Exterior light is bent. Correct or replace if needed. • Caulk clapboard where it butts up against the door frame at the community room • Second coat of paint on the door and remove paint from the windows. • Ser nails on casings of the doors. • Two community rooms should have a dummy door grab handle on the left hand panel. • Caulking needed between clapboards just above the two center windows; prime and repaint. • Left hand most window at the First floor, clean the dirt and reinstall screen. • Remove the cork patches from the windows. North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 9 Eastern ElevationAbove Storage Room • Satisfactory. Adjacent Elevation at the Storage Room Door needs to be primed and painted. • Need a concrete stoop outside of the exit door to the storage room above the step of more than 6". • Remainder of elevation is satisfactory. Eastern Elevation above the Exit Door from the Stairway Short Elevation Where the Building Changes Direction First Dormer at the Eastern Portion of the Building Rear Elevation of the First Dormer of the East Building_ Inset Area between the Two Dormers at the Back of the Building • Exterior door needs be pruned and painted • Remove concrete sludge below door at stoop. • Screen missing from window to the left of that exit door on the first floor. • Remainder of elevation is satisfactory. • Dirt splattered in and around the first floor windows at the hose bibb; clean and remove. • Dirt splattered at the concrete on the first floor, window to the left of the double windows; clean and remove. • Third and fourth clapboards need to have caulk at the butt joints; prime and repaint. • At corner board around the second floor, where the corner board butts into the uppermost corner board, sand down, prime, and repaint to make flush., • Satisfactory. • Wood railing on the third floor needs to be primed and repainted Fill the major cracks. • Band board at the second floor windows need to be repainted. North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 10 North Face of the Eastern Dormer Eastern Elevation of the Eastern Dormer Portion between Eastern And Western Dormer Western Elevation of the Eastern Dormer • Remainder of the inset area is satisfactory. • Paint splattered on the first floor windows and screen; clean and remove. • Weatherstrip seal is missing from the first floor, left hand most window. • Plastic window sills are damaged with cracks and a pieces missing on the fust and second floors; replace or repair. • Touch up the corner board to the left hand most window, the bottom by 2 feet. • Remove hornet's nest at the soffit on the third floor. • Remove cork patches on the windows. • Repaint at the dryer vent popping through side wall, paint the surround at the band board level white, not the clapboard side color. • Remainder of the elevation is satisfactory. • Conduit popping through the concrete to the right of the first floor window. Cut back to at least the face of the foundation, infill hole. • Clean the dirty screens on the first floor windows. • Clapboard just above the windows on the first floor, between the windows is out of the face by 3/4" to 3/8". Push clapboard back so that it is touching the clapboard beneath it, prime, and repaint if needed • Satisfactory. Back Elevation of the End of the Building • Satisfactory. North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 11 East Side: End Elevation of the Eastern Building • Caulk uppermost clapboard below the band board on the first floor, prime and repaint. • Repair or replace damaged clapboards • Turret end repaint shingles below the window on the first floor. • Remove warped shingle` just below the third floor window; reprime and repaint. • Clean dirt splatter from left hand most window on turretbelow the first floor. South Side: South Elevation between Turret and Eastern Most Dormer • Remove debris. • Provide coat of paint on remainder of trim on the exit door, prime and paint exterior of the exit door. • First floor window to the right of the exit door, remove yellow paint on the top sash. Eastern Elevation of Eastern Dormer • Broken window to the left of the exit door, remove and replace sash/glazing. • Touch up the third clapboard from the bottom below the window on the first floor. • At the second floor window, below the sill, caulk the staples that were used to attached the shingles; prime and repaint shingles under both windows. Front Elevations of the Western Dormer to the East • Paint on screen of middle window on the first floor, clean and/or replace screen. • Remove debris from sill of the first floor, right hand most window. • Remove needles in the screens of the right hand most and middle window on the first floor. • North Andover Senior Housing - Exterior Punchlist June 26, 1995 Page 12 Front Elevation between the Western and Eastern Dormer of East Wing Front Elevation of the Western Dormer in Front Western Elevation of the Western Dormer in the Front Elevation between the First Dormer and the Main Center Section of the Building Eastern Short Section of Center Dormer South Elevation of Center Section and Mail Area and Parlor • Prime and repaint the railing on the third floor flat roof area. • Fifth clapboard from the bottom is damaged below the window in this recessed area; repair, prime, and repaint. • Caulk nail heads of the window on the western dormer, prime and repaint. • Third floor, replace the warped shingle just below the right hand window set nails, prime and repaint. • Remove dirt at the middle window of the first floor. • Clean paint from the screen on the right-hand most window on the first floor. • Repaint the gable up at the third floor. The shingles are painted white and not the beige colors as the rest of the shingles. • Touch up trim on sloping gable just above the third floor window to the right of th dryer vent. • Clean screen on the first floor window, double unit. • Repaint steel through wall pipe which is rusting; prime with proper metal primer and repaint. • Clean paint from sills on the first floor, double window to the left of that through wall pipe. • Touch up and caulk nail holes on the corner boards; prime and repaint the entire corner board. 0 To be reviewed with entry Portico later Location //o No. No. Date MORTh TOWN OF NORTH ANDOVER .. 9 Certificate of Occupancy $ �7fsA SMUS '('C' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee c,i 4 N $ TOTAL �J $ Check # 14 6 Building Inspector "1 LO J z C j O O 0 Q U_ Q J CL :1 ► ~ � a 0 z UL O w Z CL Z O C7 H Cl) z d* +f► 1 0- 9 o 0 p. t-. CD CC== ca -0 N . (D c c d �p L Q "1 LO J z C j O O 0 Q U_ Q J CL :1 ► ~ � a 0 z UL O w Z CL Z O C7 H Cl) z d* +f► 1 r cts ►p 0 0 ..o m 0 OL 0 ILL_ s CU QQ CSS L (6 m OUc�N.c p ca -0 N . (D c c d �p L Q L C a) cu -0 O O E coCD .0 N U c (U L cn CII C E T . C4.. ,p cu Q) m U CSS O O L .� .V+r C Q=C70 0 U —0 . .0 tt3 � 'U ' N CL) U " c o L a) > + L "0 L C = r cts ►p 0 0 ..o m 0 OL 0 ILL_ 0 LUa LU U U Q w Cn Z J J L_0 r U_ J a a LUa LU J a O Z Q . �i [y W J U_ Li H a 0 s CU 0)0-0 CSS L (6 m OUc�N.c . ca -0 N . (D c c .Ln L C a) cu -0 O O E coCD .0 N U (D Q) 0 —_ Ln C L cn CII C N C C CSS CT cu Q) m U �._E(n Q C m N a) C2 cn 0 C � w �+ O C cu� CL) U " c o L a) > + L "0 L C = co N O O o cu C. aa) a 0 in .o° - c E m cn c �� a> a) o m cSs a Ec= cu c ` O Q O L O C N cn O () z �� aa`, E -a V L Q) E a c o c U .• M a) O cn O L U C Z cc .0 a°co 'u5 0 LUa LU U U Q w Cn Z J J L_0 r U_ J a a LUa LU J a O Z Q . �i [y W J U_ Li H a 0 Z ^ c O C c T m c c� Y m � L � O L O O L U1 a.- 'a C U C C C1 c4 .Q cm �u)����� V L 'a Q ch E 2 (D cam m� > o U)c c •� — )cu - = .N Uc-oO 0 LUa LU U U Q w Cn Z J J L_0 r U_ J a a LUa LU J a O Z Q . �i [y W J U_ Li H a 0 i V�I QZ J w To: From: Date: Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 Memorandum Bob Nicetta, Building Inspector Kathleen Bradley Colwell, Town Planner 0)r - March - March 20, 1996 Re: "Heritage at North Andover"- Sign Of �1ORTN 1 V Oet.�eo O A The Planning Board has reviewed and approved the proposed sign for "Heritage at North Andover". The sign as approved will be 4' x 4', constructed of wood, with a white background, burgundy and green letters, and a burgundy border. The sign will be placed approximately 15' from the property line as shown on the attached site plan. If you have any questions or comments please let me know. cc. Gloria Walker (0 copq6) Gr)8A683- 13 00 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 O D z OOJ E RNO s 'tip • ':. sre�c .r u H Lr O _ •� � �� O �OlL O I a0 •r- G CO r --i ao a co • •� m r4 •b Q) •-q J v is rI ter•, .I.J (/j (]� w ro w CJ i •r� I E C3 a O • 7 �1 v O v 'd ^ • U M. v :� Q4 • O O cn c� • E v O • S -I r.0 > • O +1 w • G w .Cv o O '. • G v O �• U O 0 � • v > d • p o • a a -W CO • v v O o • 2) 54 z 1 • w co y�• G O o . U -4 J..) CID • —4 b 3 Q) �• G o • � � U aD r • E w G • S -I w r -I O • v o cn cd v O• Cl) r•4 O •r -i 3-+ r -q rI C -- ca Ri v E O \ aQ r -I 7 • G a0 "- C!i ri v v W C a r -I H •r� (7, •ri u U • (ll w G O H U) H •r-! U G •� Z FG E as O v] O V O G G v G O O .0 < cJi C/1 .r -I JJ �..� H n �4 .4-1 O r. cv v m O r. U > 8/3/01 Revised Heretage Al North Andover Beth Valente 700 Chickering Rd. North Andover, Ma 01845 (1) 60" X 38" Extruded Aluminum Sign Painted White (16 Sq. Ft.) (2) 4° X4' Extruded Posts W/Finnials Painted White (2) V Carved Hdu Sign Pannels Gold Leaf & Painted Copy (1) Install As Per Designated Site Permits By Others File Mame: Heritageand2cdl 60 in An Assisted Dving Cmmt l v 976=6833-1300 '(Il(C CHCKEFJNG ROAD !`��, 6>tlt" I` I'n.a cam 4 L�:,rveCU370MERS: Please proofread and approve all Copy. 11nalandproof back before Start of job. uramew JNY9JU0aI �cTeRlox• 6IGNAGB ✓� 9CrcB�7Y�0°t'MM ''A�BY 914N.As ResNeed OQ UWU 8K MM" MA M4 978.704.2071 • FAX 979.666-1841 38 in 30 in TO/T0 39dd NJIS h3AaVH Tb8T9898L6 T6:ZT T00Z/Z0/80 N v� 0 � O bA � P ce a z. 0.0 O o O a� od�R A 19 o a o IPA ice+ �C.r 00 r ,� o a "d v o V �" 40-1O O ' � 0 � U1 boa16.c O wo•�-'o PO 64O c .� PC 'A �N �00 0 4-4 x CISo '� 0 N o rn z N Cd Cd 64 o o s o 0 0 U 0 E-+ o bD •° o .� 0 o 134 W 0C's o C 5 0 Q" o � cd 64 0 4) A of 4t (90mmDltlU all of Massar4uatts. Bepartmeut of Public Onfag BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. 3 Occupancy & Fee Chec 3190 (leave blank) L Y 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 1_2Q1_9(15 City or Town of_NORTH 61,110VE R To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) VINO c H 1 C K r- R 1 N L ISOI"> LHSIR 1 1 A WF AT tb ANji61,L�?� Owner orenan Owner's Address 16 0 i= E I)C�t rA L ST kS l 01J, r OQ ACA Z Is this permit in conjunction with a building permit: Yes U No ❑ (Check Appropriate Box) Purpose of Building CS t 001 WA K Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps -J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal F] Other Local[:]Connection No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring a No. Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Com_plepd Operations Coverage or its substantial equivalent. YES 2 NO ❑ 1 have submitted valid proof of same to the Office. YES 8" NO ❑ If you have checked YES, please indicate the type of coverage by checking the approp riate box. INSURANCE (B BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ 1 1'a00. 00 Work to Start`s _ a c A — -t i0 Inspection Date Requested: Signed under the Penalties of perjury: FIRM NAME SU(-'FGL iF V-_L,EC_ R[CA,L CO 11Q0 Licensee Address ,(Expiration Date) Rough W �_)Ulv-�U Final W OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ 0• (Signature of Owner or Agent) x-6565 COMMONWEALTH OF MASSACHUSETTS OF ELECTRICIANS REGISTERED MASTER ELECTRICIAN ISSUES THIS LICENSE TO SUFFOLK ELECTRICAL CO INC y ROBERT J FOLEY 4 BOYLSTON ST JAMAICA PLAIN MA 14204 A •: 009257 r ";'-: DfPrFATIQN HATE; = MEBIAIsj10.: M Jcro1d A Cn vao `(`,Qnlnlomrealch' REGISrsrAR _v assach�setrs } ` .t..rc � _fir �'- • '''wYi � •- fit?% �- n .�`� �• ■ r 1 r . +. H O y. M W q LL 1 Q cC ND o -4 L,; U W H U 0 O J Q •-( in J N Sao i z W O Or � w • E M N ix m <r LLJ OL z m r ( wF" • -� o �' d.e O prl- N :e a W r to •O N O o• Z • • O� N M � '- '•" O W (A O, 1 •-1 r �' : iv N N ►- o \v\ ,�`�l J •rl O� O N .o � Q' X \ Q O W H O Q' M O H J L— Z .—, Z O O 11 w Q W j`1 O O fl U z J g3 HIM + o U ons w oa I >L ►- (n U (Aa ..;;. y.tR. L (.) 41H W0 Q vs z .nirOf ;` U e (n4) v m m� -' w= (n 4) O O Q W z (n m (n cx v ti I i t .�-. �wC:_.—=:C*�ifs✓'....�:�-.*-:...:.Y .e.ti[—�-✓"7.r-..--r ..:-,..---•r r:=� 'iw.R",�* '. ,„�. . ..:r .ems. � �. ..' .:� ! Date .... 2 2 ..�i J-a 336 ,tiC. 3? e�,r •'•..`e O� TOWN OF NORTH AN VER PERMIT F W N& t ,SSACMUS� I' This certifies that .......sb....., ......... ...a .� VIP has permission to perform ......~ A....... ............. wiring in the;buing o . .. . . .; at ...7Q..�....""'d, ............... . North Andover, Mass. Fee 5k.: Lic. NoF ./..3.9`/.......................................................... ELECTRICAL INSPECTOR z � WRITE: Applicant CANARY: Building Dept. PINK: Treasurer U� The Commonwealth of Massachusetts Office use Only Permit No. DcpartrTirnt of Ptrhiic Safety ' Fee Checked EIOARD OF FIRE PREVEN`1ON REGULATIONS S27 CMR 1200 3/90 Occupancy S (leave blank) APPLICATION FOR PF--HMIT TO PERFORM ELECTRICAL WORK All —ork to be perk)nnrd In n<Cordnncr willh [hr Mnecnchucrnt Flectrical Code. $27 CMR 1°'00 (PLEASE PRINT IN INK OR MEP ..T.. INFOItI- TION) Date City or Town of OP �N�OdG� To the Inspector of Wires: The undersigned applies for a per -mit to perform the electrical work described below. Location (Street & Number)[,�1/N Oc.•ner or Tenant,pL'1 4 _. O-.mer's Address / VV �ViZ6-1 d.✓ ASR /w- 6"�Op Is this permit in conjunction with a t,tilding pet -nit: Yes ❑ ho (Check Appropriate Box) Purpose of Building C�Li/S%to� '46A. •Ij N��nsT Utility Authorization NO. Existing Service Am r Y & ps _/_ 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 Elect•,i.cal Work 11 A A fi, /1 n — f Coe 64-ty 1Xk4AA"" No. of Lighting Outlets No. c Hot Tubs / No. of Transformers T A l No. of Lighting Fixtures Swi,ing Pool Above In- ❑ m;grnd. grnd. Generators KVA No. of Receptacle Outlets No. c,f Oil Burners INo. of Emergency Lighting Battery Units No. of Switch Outlets No. cf Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local 11Municipal ❑ Other Connection No. of RangesNo `° Total f Air Cond. tons No. of Disposals No. ;.f Heat Total Total Pumps Tons KW No. of Dishwashers _ Space/Area Heating KW No. of Dryers Ilcacing Devices KW No. of Water Heaters kW No, cf No. of Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of: Motors Total HP uIrltK INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance oli.cy including Completed Operations Coverage or its substantial equivalent. YES ® NO [] I have su`mitted valid proof of same to this office. YES[,' NO C] If you have checked YES, please indic.:te the type of coverage by checking the appropriate box. INSURANCE ® BOND [] OTHER 0 (P1e.re Specify) Estimated Value of Electrical Work Expiration Dater Work to Start [:ns ^.cti.on l?nte Requested: Rough Final Signed under �the Jpeen'alties of perjury: FIRM NAME /T /' 6 � _._ ___.----- LIC. NO.� 6 - Licensee J /1-070 L/rte / �1/� -- __5� ,� J SiAf nature ✓ LIC. NO. ! 7 70 Address �b l7Ct/1CY.r1 (i �yG"['rI /`'%'1-l/ Bus. el. No. J _.� OWNER'S INSURANCE WAIVER: I am aware ,;hat the Licensee docs not have the insurance overage oritssub- stantial equivalent a;: required by h1as;;achusett:s General [l -s, and that my signature on this permit application waives this requirement. )"Ier Agent (Please check one) a/ ) _ __ Leleplton� t:o. PERMIT FEE 12,f C/ Sic_naturc of (h��r.r' nr Actr.nl� �,� -- •r'+si?,*,�-+�:.i•W `t:.+•a+��i `'-r.::: `-�" ••- -•wry}i.L''•dv�'�:r-:riY`r.�:�.w..;+.,,��.:q^t" �y4r�::..'v".. .�,,,;;+.'Y�'r-••e:-�a+y-,� lY i- 2649 Date . v M HO„TM TOWN OF NORTH ANDOVER it e` a OL PERMIT FORMS INSTALLATION$. m ..r This certifies that . y 9 has permission fort/ installationACt.�;�1 in the buildings of .. //r,?!.t4 /.f S 'S op .L �,•1:,t ........ at 7UU. �.�d" 0I(,� tic ... ., North Andover, Mass. FeeLic. No. `7r.% .... ........ ....... . C k f/j INSPECTOR WHITE: Applicant Ci CI/RY: building Dept. PINK: Treasurer GOLD: File Location 'CCl Lo -n � k) No. o?31 �� JDate a Z N0RT1y TOWN'-OF NORTH ANDOVER �?Oftt`'O '•,�'O :. Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ 3 �9( 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 Check # // qV 15954 -A ( CQ,4-� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING eOfficial Use Onl .glEa ;;This Section for BUILDING PERNUT NUMBER: ?, 3 DATE ISSUED- ) 59 2 V`- SIGNATURE: 'A Buildim Commissioner/I or of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 76 T -1111, bo Map Number Parcel Number V v&� `Zoning 1.3, Information:(/ 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide R ed Provided Required Provided 1.7 Water Supply NLG ,.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ �1F I 1y ..q.Jy Z J ..F.:. t:% V Yee ilY 5+#22 �yi� AMC, 2.1 Owner of Record CA Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Signature Telephone ME 3.1 Licensed Construction Supervisor Not Applicable ❑ was 5 �,S� Address r License Number % 1 /G ) ��� A A y . 7 Construction C�� ✓ 7'k- w , 9,, &g�` �j� `�"" a`FJ Expiration D e / Ize-0 3 Signature Telephone 3.2 Registered Home Impnivement Contractor Not Applicable ❑ Company Name Registration Number KAda; d r. s s C� 9 779J % Date E�F11 ��� Ql� Signa t� I eelleephone ic Z v n M 0 Tm N z 0 z M 90 0 D 3 r v M z G) SECTION a WORK R 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 Yea .......❑ No....... ❑ 5-PRfl�IOiLTEISECTION GAN S�'Rt1C7IONURVIUS AND $i'RUCTMMS S C TO CONTRTiCTIflN C't3�flL PTART TU'; G1Ri'[KCUI'�ITA1N 1V+1�D,1 _F._bEC51N iD Si'AC} t 5.1 Registered Architect: Name: Address Signature Telephone 3:2 RegisteFe'ro%siena!% Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: ' Registration Number Expiration Date Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date C pany N Not Applicable ❑ *�,2=iblein Charge of Construction New Construction 0 Existing Building ❑ Repair(s) ❑ TAlterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of/Proposed Work: ]A IB ❑ ❑ U O UL11 ❑ Independent Structural Engineering Structural Peer Review R Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Owner of the subject property Hereby authorize J 1 ° S V'V Z� N 3 to act on My behalf all matters relative two work authorized by this building permit application Of Owner is 2auz Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ ]A IB ❑ ❑ B Business ❑ 2A 2B 2C ❑ ❑ ❑ C Educational 0 F Factory ❑ F-] 0 F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ I histitutional ❑ I-1 ❑ I-2 ❑ 1-3 ❑ M Mercantile 0 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility M Mixed Use S Special Use ❑ ❑ 0 Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: Independent Structural Engineering Structural Peer Review R Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Owner of the subject property Hereby authorize J 1 ° S V'V Z� N 3 to act on My behalf all matters relative two work authorized by this building permit application Of Owner is 2auz Date 1, ,as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name v � i tore of Owner/Agent Date cVWN e Item Estimated Cost (Dollars) to be ym0" A'_ Completed b t applicant P Y Peri 1. Building, i a (a) Building Permit Fee 7 Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number "� �`� `a5$ � / V g 444�Jf 1 YY-- )j Y`h Pz'..K lr« 1r.Y �r NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r`�Vs' a rA cz w 0 PQ u u°. p::jZ cn H U � z o .� � w° v U G w 0 w o a: G rS. o W W W o w v ubID cn C w x p U z x to o w G ix. z a W � � y w W ° z 8 cin Q v 0 cn ui o c � o ` c N ci YC2m N = E t E_ oL O o cm m c m m� a y a N N C O :.E N CD CL :nwL�CC m ca CD = o vs �no c _� S',a 'S _. m C m O V •y O �. ca n m 'COL C N ~ 0 N O ~ t W •y n .zc z c'rm V E 0-0 O CD ; m O '-CC V- CO) nO O S .0 ` ti O 2 O I 0 crW W crW LU U) North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signa a of Permit Applicant to �S-2 e�z Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ACQM CERTIFICATE OF LIABILITY INSURANCE 1DATE (MMID 0/11102°""' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION B.K. McCarthy Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10 Centennial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody , MA 01960 978 532-5445 INSURERS AFFORDING COVERAGE INSURED JNR Gutters, Inc. 114 Hale Street, Suite 204 Haverhill, MA 01830 COVERAGES INSURER a The Travelers Insurance INSURER B: Liberty Mutual Insurance INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NMW 7A I TYPE OF INSURANCE – – POLICY NUMBER DAA El FE= POUCY EXPIRATKIN- -------- y_-- -LIMITS - - A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FXI OCCUR 1680877Y61651ND01 06/12/02 06/12/03 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any one fire) $300,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY PRO- LOC PRODUCTS-COMPlOP AGG s2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car 1810865H66591ND01 06/21/02 06/21/03 COMBINED SINGLE LIMIT (Ea accident) $500,000 X X rX X BODILY INJURY (P- PSI $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTOONLY: AGG $ $ A EXCESS LIABILITY X OCCUR FICLAIMS MADE DEDUCTIBLE X RETENTION $5000 ISFCUP1987W6761NDO 06112/02 06/12/03 EACH OCCURRENCE $4,000,000 AGGREGATE s4,000,000 $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC231 S330775022 09/20/02 09/20/03 WC SLATU ETH - E.L EACH ACCIDENT $100,000 E.LDISEASE -EAEMPLOYEE $100,000 E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNMCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECUIL PROVISIONS Evidence of Insurance SHO100 ANYOF OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION JNR Gutters, Inc. D THEREOF. UING INSURER WILL ENDEAVOR TO MAIL 10 DAYSWRITTEN 114 Hale Street, Suite 204 OTICETO E/ ATE HOLDERNAMEDTOTHELEFT. BUTFAILURE TODOSOSHALL Haverhill, MA 01830 IMPOSE O I A ON OR LIABILITY OF ANYKIND UPON THE INSURERJTS AGENTS OR Z . K§ G co \0 o 2 � �c \ $ƒLU ( a / ƒ m �2/? 7 z \ 2_..\ �7 / / �. ) &a. o C\j o LL./ 0 m } LU e f2o/ § a.. 0 fƒ \w00� /o \ 12/ L � co co G / Z I / o k K- y 2 £ z / � '� ` \ 2» J \ §. 2 / 2 .I 7 _/ o \0 o � z / y 0 \ { 7 z \ 2_..\ / / / �. ) z o C\j o . } LU CS) \w00� \\ _§:.E �0) X. / '� ` / ?` « §. 7 _/ ƒ \ U) 00 D:D ®a Q f \ / M ` Location '700 19,0 No. 400) Z T Date 1 d q 4 jj 7832 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundations Pe5mit Fee $ Other Permit Fee$ ZSR t Sewer Connection ee $ Water Connection Fee $ TOTAL $ ZS Building Inspector Div. Public Works i a0 a a. 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C3 CO) C � O CAco n 0 Z y CLO r� O � C mm CL y O CD CCD `v O CL Q CD CD O CD C CD y� Q v y O O I CD CD � v CA O 1 Z CD 0 O CD 0 CD E�� Z I IN L Lr `-1 C O 0 Z 0 ft rr m 0 ca 0 c CL tG CD co C OCL CA N C 0 5 N CD m )mi 0 9 0 P=h cn cn w O of 7z S o E o �m O 'O m H n N f! ?? ?'Co ca m n CL O.?d cn CD m y _I O o?m�m �� I a O � No m O > O p a -i_ n O o m :A f9 v^ O o s� CL 0 m O N N ,omCL a < r CD m w ac N w d d d QQ C a CDCA O C N .i o CD so CO) CD ts 'Cia a�n O � o �a :K x ; CD n CD o m N x a o W : � nom. n o C y M d c ' C— eo m )mi 0 9 0 P=h cn cn w ?? 7z n? cn ?? �o m n cn ^ C O CD O O O f9 v^ O o v < Cr1 w w a UQ a�n x ; r x a � n o C y M d o O r d r It o I� a� O C Location X/F TGA G e e i No. .S' i C � Date fl % TOWN OF NORTH ANDOVER 6 0 3? � O p Certificate of Occupancy $ Building/Frame Permit Fee $ do �44CHFoundation Permit Fee $ Ch Q Other Permit Fee $ a Sewer Connection Fee $ r Water Connection'Fee $ TOTAL $ d Buildind Inspector .c 396 Div. Public Works Q PERJIIT NO. -A % APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 �4AP KVO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO.I LOCATION PURPOSE OF BUILDING �11.[ksI1�4 % �Z1ti OWNER'S NAME NO. OF STORIES LkSIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DIMENSIONS OF SILLS DISTANCE TO NEARESIF BUILDING 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 BUIL ING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES P4GE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 .�ECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED p / g2lq 7 PERMIT GRANTED 0 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY WILDING OWNER TEL. # CONTR. TEL. #4a7� �6 CONTR. LIC. # /G13qt24 H.I.C. # BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH B 1 2 13 PINE HARDW'D PLASTER CONCRETE CONCRETE 8L K. BRICK OR STONE PIERS DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/1 1/2 t/, FIN. ATTIC AREA _ NO SMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ DROP SIDING WOOD SHINGLES CONCRETE EARTH HARDIV D COMIACN ASPH. TILE ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK N MAS NRY BRICK ON FRAME CONC. OR CINDER BLK. ATTIC STRS. & FLOOR _ WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH Q FIX.) _ GAMBREL MANSARD TOILET RM. )2 FIX.) FLAT 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. 6 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 — tst 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. IV# i m O x: o w° v /) a cn p H Q G s C wo 4 v U q xc�' O a o M C H U + U w: o co C w a o oG Q w' H W a w W z b cn v cn t '*4*- w z c o O c � •. W o � � O C ea c CO Jso CD Ea m c (� m m E c O o - o 0 a W E co U `` H H �3 z C/) co O EM U r) :a0� m LA m' Cl) :acs .�:mo� m C.3 y o o U Z O c o c_ C=, m C C = m m 0 N O. Vi m_ .y. m O C O F- CA n.=Z CO2 CD uj V m G 'm0 C J a m�o� _ .0 O N =Y O c C O CD r+ O O V z 0 a O C/! M I o .cm H O O F— m m CD 0 CD CL F— � CD •� 3 -a C5 co L Qo a' C. CL CMa cooc C) Cc ca CL O cooC z s 0 CL C Location A)67 . No. -39 Date �57�", e NORTH, TOWN OF NORTH ANDOVER F p Certificate of Occupancy $ Building/Frame Permit Fee $ '' s '°' E � s�cMus t Foundation Permit Fee $ 7 TWA Ltr,.s --3;, Other Permit Fee $ 75' J' Sewer Connection Fee $ Water Connection Fee $ TOTAL Xt i r_q, 7519 $ x- �v Building In ctor I75. 0 PAID Div. Public Works PViNfIT NO. ISIS APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 1� a MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE SUB DIV. LOT NO.I 'LOCATION �L_t GICC-7Ll w, K W PURPOSE OF BUILDING y�� P4NER'S NAME �Q/1T/�L�' NO. OF STORIES SIZE 01yNER'S ADDRESS�►rc��Il 9 10 e BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD ILDER'S NAME / CT„ SPAN --- -/ DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS "" POSTS DISTANCE FROM STREET 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 IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS .�7//— SEE BOTH SIDES WtA=)% PA �I�'-- PAGE 1 FILL OUT SECTIONS 1 - 3 ,�'` PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING r ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 170 —! SIGNATURE OF OWNER ORA THORIZED AGENT 4p ox FEE I4qwpr" /7 r PERMIT GRANTED 9 19 �}- - 77s;e,l 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY OWNER TEL. # CONTR. TEL. # CONTR. LIC. # H.I.C. # i BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S'"OkIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION CONCRETE 8 INTERIOR FINISH PINE HARDW D 3 t 2 13 CONCRETE BL K. BRICK OR STONE PIERS PLASTER DRY VJAII UNPIN. 3 BASEMENT AREA FULL FIN. B M AREA _ '/. 1/I 1/1 FIN. ATTIC AREA N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS II 9 FLOORS CLAPBOARDS CONCRETE EARTH HARDW D COMMON ASPH. TILE B _ t 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. 8 FLOOR _ CONC. OR CINDER BLK. WIRING _ STONE ON MASONRY STONE ON FRAME SUPERIOR I -A POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3BATH FIXE _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT 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 II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS GAOILS 7 NO. OF ROOMS B'M'T 2nd _ t -f 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. H w A ¢ j� pQ w° v , v� x ° z z a C 7 z w7 C4 ' U w a ° z z rL cz w � 0 w z U U W 7 � > cn m w o w a z ¢ C7 :3E 0G u, w x w w ° z cin f u ° V) O FM4 Ou M M ! Q z 1 n La i g= ;oma O CO) O QU n= :r a co o � vr^ N EQ a' c t as o co O ~ O' I-- 00 O a as c n;:. . ' co) R Cu ' C � . m CO CO) C Zr as N /.r Qr. ..o O • (P VVy C > c oQ CD y O eov•�Z c o n _ m= o a H N — CD CO) 'm t0) m W O �•r CL-. CO) a ev *,M- c O •N 2 cm C3 .0 p C.= C_ CODa � 0: O = CC zip COD m N •O f- r CL.- CO Cl &I CD 0 C oc L O o Q Zco Q O y C C I CO CM CA CD COO CO m m CD O O � H_-+ CD O.a O i co CDL �C O Q ti C O *�-� CIOO V J� EL, CZO �0.. C Z CD �..� 0 CL VA !C C y c a Z LL z O Q LU U) z O U J Q z Location -7w CrhC No. CX,f- 1 Date 2A TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fe je j[,$ ZS Sewer Connection Fee $ Water Connection Fee $ TOTAL 7943 (�FL) $ Building Inspector 2103 PAio Div. Public Works PERMIT NO. Q� j APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. PAGE 2 FILL OUT SECTIONS 1 - 12 LOCATION , C) a/ PURPOSE OF BUILDING OWNER'S NAME �^'r�."Vyz j e, ,�. rG� �/ //'ASEMENT NO. OF STORIES SIZE OWNER'S ADDRESS w K• OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING % IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES Ufa 1c.�L PAGE 1 FILL OUT SECTIONS 1 - 3 5 U v PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING"�"r"—� ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED ANDD APPROVED BY BUILDING INSPECTOR DATE FILED AGENT FEE z,~.dU PERMIT GRANTED Q 19 1-s 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY INSPECTOR OWNER TEL. li CONTR. TEL. # CONTR. LIC. # H.I.C. # -?�4 > C4 BUILDING RECORD 1 OCCUPANCY 12 b SINGLE FAMILY STORCES IES MULTI. FAMILY OFFI APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE HARDW 0 B 1 2 13 CONCRETE 81. K. BRICK OR STONE PIERS PIASTER DRY WALL UNFIN. _ 3 BASEMENT AREA FULL FIN. B M AREA _ '/. 1/2 1/. FIN. ATTIC AREA N_O B MT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS II 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING HARDW D COM/,ACN ASPH. TILE VERT. SIDING STUCCO ON MASONRY _ STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STIRS. &FLOOR _ CONC. OR CINDER ELK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I-1 POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBREL] FLAT NIP BATH )3 FIX.) MANSARD TOILET RM. (2 FIX.) 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'T 2nd _ 1st 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. cl u e CN o O o Ca v u aG o w° Q' ci a p z z � •° L w° Ecz U LC O z -- G m w w z U W > cn w Q �' U � a r°G m wcn w G w A w c z v o O :•m C r:. O c o � c ` O y Cp O V V d O tdr : m C := o • O L ! y Ea m o n H � c o m oo `- O: O : a = E y = cc = O V! y O C O m CM CD m +. 'C C a.o� o ;mom m �V y O G , Z :r MC� cm ►- o y m$~ m LLA 00 c v� cma y O LU C2 CD CM y a o� o� g = R ai"S O �- � *- m zip K O O E coL O O v Z � O y D � _ CO CM coo L** co W W L- �CD = co 3� O i co OCL i tC O Q �Q y O oCCc ,Q� O � CO) Z co UCO) O C c cc CLH 0 Y z 0 Q M� 6L w C/) z 0 U cc W Q - jo Dated NORTH °'.. •° .�� TOWN OF NORTH ANDOVER .- ; PERMIT FOR PLUMBING 40 r off+ ...... • ,SSACMUSE� This certifies that1�' . R ". . �Y............. . has permission to perform plumbing in the buildings of .��`�.G�`�'`� at.lm? North Andover, Mass. Fee C) ... Lic. No. ................ GP� MB NG INSPECTOR Check ,+/ �JDG U 6 5 u 8 70 LAG P'LU6P,�16xG. jau ' . r. Dulidinr. LcrcaUan 00 C11K.IC,f ►.t�, �eaall : Ast1C14N1� .-,ca_�r.1x.. �hr7er L. IvLrr_• �-_ . lji , ❑ Mid IrIstaft Cotnpu►y Mame Y �t�vtA6 Check one ' address_ y o g �C.128 Certificate y corporation - 1&09 — on o. AMDoy _ I rVlr� nIPt1C" p Partnership Fj� 8usinesa TNephone 9'%B ��% �. Zg 41 ❑ Ffrrn/Co. < F ;Name of licensed Plumber-- . 1R AWICE COVERAGE: I.hatro.a =urr Yes No ❑ e Ifalafty insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. U you Itave o6c=ked M. please indicate the type coverage by checking, the appropriate bout A Iiabliv insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WArVER: I am aware that the licensee does not hxve 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: �Mafure or Cirmer or fvnehr'a Agent `fie ❑ Agent ❑ I hereby ON* that all of the details and infomntim I have submitted for entered) in above application are true and a�urate to the best of my knM1edge and that alt plumbing wort: and hsWtations performed under the permit issued for this appii=tion wi PWWWtprovisions Of UN Massaehuseffs State Plumbing Code and ChTier 142 of the General Laws. ll be in compliance with all r L+w ,Wo rwmner (ilv/Towo Type of License:.tvtaster`� .lourneynw ❑ : t NL) license Number jj=��- 9- enovau ❑ FreptacernerdPlan: _:ubmfhed: Yes C Fix -i URE / 42 0 9 eo;* "Y q......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ...................................... ........................ Phis certifies that ........ has permission to p( ..... M .... ....... .. ............ wiring in the building of .. . . at . . . .... .... ..... ... .......... . North Andover, Mass. Fee........ ......... Lic. No.. ............. *i�E-c-r* R*i'c* A**L* *I* -Ns' P - E' c*-*r*O** R Check # W9 M**... z7--I O'l 1 �N 4, Commonwealth of Massach m Department of Fire Servi g BOARD OF FIRE PREVENTION REG APPLICATION FOR PERMIT TO,, All work to be performed in accordance with the'vt (PLEASE PRINT IN INK O PE A INF T10I T City or Town of: By this application the undersigne gives no 'ce f is rbtr in 4 V Location (Street & Nurol er)__�7 /V�1 Owner or Tenant M A;h1A JAY2 Owner's Address vtts' Official Use /On y Permit No. 7 s Occupancy and Fee Checked. TIONS [Rev. 11/99] leave blank ERFORM ELECTRICAL WORK achusetts Electrical Code (MEC), 527 MR 1 .00 Date: To the Inspector of fres: ition to Mrfprm the electrical work described below. Telephone No. r Is this permit in conjunction with a building permit? Yes ❑ No C9� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Comnletion of the following table may he waived by the Inspector of Wires- No. ire - No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges b No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained p Totals: Detection/Alerting Devices No. of Dishwashers S ace/Area Heatin KW p g Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances Kit SecurityNo. ofYsteDevices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach aaattzonat aetait y aestrea, or as requirea ay the inspector oj rrires. 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:) (Expiration Date) Estimated Value of El ctrl l Wo : (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: 1 8330 Licensee: John S. Bassett Signature _ LIC. NO.: 1533 (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Li*see see 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: $ t€ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING `13 oG (Print or Type) �-�-Mass. Date Z - �% 19 / Permit . - dOwner's Building Location '70D Ci i Fri �ti� Name A05 cSC�//l>2 Type of Occupancy ,-L04r2zi `�DUc5lti9 G New 2"- Renovation ❑ Replacement ❑ FIXTURES Plans Submitted: Yes ❑ No Q-' Installing Company Name(lxl O Address _ _'�o' D - %wUx /'01`0 &-a/.5f0uu /u7�v- aj0oL5— Business Telephone - 30 2 - Name of Licensed Plumber or Gas Fitter D IL Check one: Certificate corporation ❑ P'artnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current Ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No C If you have checked yes, please in lcate the type coverage by checking the appropriate box. A liability insurance policy I7 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 0 Agent I hereby certify that all of the details and information I have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all olumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of rhe General Laws. Type of License: ( C nt By = Plumber 111v Gasfitter Title Z --Master 5 nature of Licensed Plu ber or Gas Fitter Journeyman CitwTown license Number .APPROVED (OFFICE USE ONLY) ■NNEMEN■MMMMMM■M0■■MMmm■ "M0GM■■■■■■MMM■■■M■MM■■M■ MIT •eMMIN�M■�oUn■MUMNIMMMU MMMM 1011 mor lug .. � nmtmmmmvimmmmm■mmmmmmmmm■ .ff ... ■■m■mmmmpi■m■mmmmmmmmmmmm■ orm"OTS ■M=MMM■MM■MMM■MMMMM■MMMM ORTMOMT-2■m■mmnmmmm■■mm■mm■m■mm■ ere M. ■mmm■■m■mmmmmmmmmm■mm■■m■ 09 .S, ■■mm■■mmmmmmmmm■mmmmm■m■■ .. MMMMMnMMMMMMMMM■MMMMMmm Installing Company Name(lxl O Address _ _'�o' D - %wUx /'01`0 &-a/.5f0uu /u7�v- aj0oL5— Business Telephone - 30 2 - Name of Licensed Plumber or Gas Fitter D IL Check one: Certificate corporation ❑ P'artnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current Ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No C If you have checked yes, please in lcate the type coverage by checking the appropriate box. A liability insurance policy I7 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 0 Agent I hereby certify that all of the details and information I have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all olumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of rhe General Laws. Type of License: ( C nt By = Plumber 111v Gasfitter Title Z --Master 5 nature of Licensed Plu ber or Gas Fitter Journeyman CitwTown license Number .APPROVED (OFFICE USE ONLY) N Z O P u W C6 H Z H H W cc V O c. G. J Z 0 W W V 66 66 0 0 i I'1 t W W 66 w 6" do C Z u a, 12 E s , ► 19 Date.. ,......... ,ORTN TOWN OF NORTH ANDOVER rpy tT�ao ,e 1ti O :.. PERMIT FOR GAS INSTALLATION-, s r-•. 7 This certifies that .. r...':. +..� �.� ...r.` ................... . has permission for gas installation !./ ................ in the buildings of . ft.........+t!'... t ......... ...... . at ...... North Andover, Mass. Fee.4J -�& .v,"Lic. No. r:.'. � ......................... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Location _Ze,- No. 3 Date h4 NORTH TOWN OF NORTH ANDOVER 0 Sao ,ti ° 0 p Certificate of Occupancy $ Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee -PW/It. $ Sewer Connection Fee $ Water Connection Fee $ TOTAL c3, v, 7518 $ Ps -GP eA) Building Inspector 2100 PAID Div. Public Works PERU T NO. 33� It APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE ZONE SUB DIV. LOT NO. LOCATION. 4� ® �•�A PURPOSE OF BUILDING OWNER'S NAME & NO. OF STORIES SIZE OWNER'S AD BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME / / / ifr' �O/ SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS ' POSTS DISTANCE FROM STREET 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 MATER;AL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 / to hti09. �LI�I�T ./ PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED ANDD APPROVED BY BUILDING INSPECTOR DATE B'IICED _ if�� 1s`� vl� q_ SIGNATURE OF OWNER OR AUTHORIZED AGENT 00 F E E 94i; dg' PERMIT GRANTED 19 C 324 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY OWNER TEL. # CONTR. TEL. # CONTR. LIC. a H.I.C.1/ BUILDING INSPECTOR BUILDING RECORD i OCCUPANCY 12 SINGLE FAMILY RIES MULTI. FAMILY rOFQFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION CONCRETE —I 8 INTERIOR FINISH PINE H D 3 — 1 2 I3 — CONCRETE BL K. BRICK OR STONE PIERS .! TE PIASTER DRY WALL — UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ '/ 1/I '/ FIN. ATTIC AREA NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD"✓ D ASBESTOS SIDING COMMGN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. 8 FIOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I --i POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBREL HIP MANSARD BATH 13 FIX.) TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 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. 8 COLS. STEAM STEEL BMS. 8 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'T 2nd _ t<t 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. ti Et I x o Q O u 0 u°.a0' cn LCC 0. O � z z A C c 7 p v E L C � Q U z � z �+�, p co a W � z u H w mon " cn C w U V) z inn a�'vE, C W � w GG w v ~ z V v i O LLJ Q CL z c c a� c • c � C) i • � O N C ' u Q• c :• I ev ca CL) c :z o O � H :Ea CEL as c a H c k�2� -o 00.2 .: i is CO C CA m L Ci cc 3 d J N m j N R O y a t41 V d o cmc 1 ` y CD •st o o� N p m Ci c3 y p L V •�Z p cm C O c _ N C p : cl. N a COD rp+ O a0+ m L w O 'r C _..,MD r - ...CD •NC.= LU O C Z LU 'E � ; h O m c m,°« c h CLO:a = eyv �iyC C t- z CL.-. m :1:4 :O U �w C7 Q GQ L.J y CD .y CD i W C O O v m I 7 fA O O U iiCO) C O U L O v CO CL CO) C W CM C O O 0 m m J Q z cc w a } Z F— O Z � w Q } LUCIO w z U 0 J Q z J LL Q z LL U-1 CD z � LU J W CL U) A r h Date..... 3 ° ....... iv TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION This certifies that .... ....... ..... .. .. . G ........ r has permission for gas installation .. , . .. . in the buildinngs��of ...�� - '......................... at 7 .. .Cf ........ North Andover, Mass. Fee...... Lic. No. ... A,t .. ?'`- �-;; ....... %GAS INSPE6roA Check 4 % . MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) "I 1V 0 r A1c0Mass. Uate_-.►U�Ify Permit x 7+ B.uildir g Location _ OD 0-14l` -k*a21NG, j � Owner's Name 1 tSI�L1<ti t F(AI�d�1/� xi ;Type of OccupancyvV1ia2.G� New p Renovation p 1 Replacement Plans Submitted: Yesp No �" hstaUinq mpany Name gLr: a Ra�1�. QLWl'b I A NyMA Check one: Address e. Corporation ,q O ❑ . Partnership business Telephone I) �i Sr �Z9� ❑ Firm/Co. Name of Licensed Piumber or, Gas Fitter -f&6E4-9LMCj4eft-F_ C�erttiiffiicate NSURANCE COVERAGE: Ihave.a cufrent iability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ lyou have. checked yes. please indicate the type coverage by checking the appropriate box. AlkMfty 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 taws, and that my, signature on this permit application waives this requirement. Check one: Sgnature of Owner or OwnersAgent Owner❑ Agent ❑ 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 the permit issued for this application will be in compliance with all Pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of the General taws. T of License: TNe I umber Signature of Licensed '7umt>er or Gas Fitter Gasfitter Oty/Town Master License Number $ 7 ( I NL Joumeyman V , E N W ¢ W N N N Y V Z ¢ ¢ ~ S N S N 6 F O t m W" to F 4 :L ¢¢ O p 7 C W F- N ¢ W 4 0 W'. = N' W W F. C N Q d O C 0 W .G W= ? H k W 4 W < C t 4. > W m= W 0U. O 2 W 0 a G M Z ¢ W>¢ x 0 v W S Z a O ¢< o O t O V O c W Y o 6 !- O SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR LTH FLOOR STH FLOOR STH FLOOR 7TH FLOOR STN FLOOR �" hstaUinq mpany Name gLr: a Ra�1�. QLWl'b I A NyMA Check one: Address e. Corporation ,q O ❑ . Partnership business Telephone I) �i Sr �Z9� ❑ Firm/Co. Name of Licensed Piumber or, Gas Fitter -f&6E4-9LMCj4eft-F_ C�erttiiffiicate NSURANCE COVERAGE: Ihave.a cufrent iability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ lyou have. checked yes. please indicate the type coverage by checking the appropriate box. AlkMfty 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 taws, and that my, signature on this permit application waives this requirement. Check one: Sgnature of Owner or OwnersAgent Owner❑ Agent ❑ 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 the permit issued for this application will be in compliance with all Pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of the General taws. T of License: TNe I umber Signature of Licensed '7umt>er or Gas Fitter Gasfitter Oty/Town Master License Number $ 7 ( I NL Joumeyman V , E Locations C Cf 'r c /irl No. - S Date NORTH TOWN OF NORTH ANDOVER . Certificate of Occupancy $ + ; Building/Frame Permit Fee $ Foundation Permit Fee $ Must � Permit Fee _-Qthc+ $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 105- ti n7;-�r�� Building Inspector iY:�y rJ•4J PAID9 6 17 Div. Public Works z c� H LO m aJ a 4-) G C a CO 4-) aJ s4 �+ w ro w U o O • :d E �4 o • • 0 �4 aJ 1 4j o Q)0 'd a �4 4 v a ro Lo a v , n • p `-7 • 4..i U t7 • E v O • �+ 4 ' • p � .� w • r4 w �o • •� O O v cn �4 G �• U O 0 �+ Q, cn V v • • y ¢ cn • �4 O �• v a1 O O z •4 • � o o � • �• � b 3 aJ co ro H • E w G �, w .-j o • v O � w cn o0 O. U3H p 3-i r -q 4 H G �c ro N cn v a) H H •� a •� w W Lo v w G O E-� 0 -4 z w E ro o v) O p., 1 o o � d cn m H +.3 H cn �4 41 O o a v 0,J cn v) U r J J J 61 •' U r O v ;� .. cz v U O z z U :n_ _ o Lo LO ` 7 C 72 1 n� r lJ oA ✓ C J r J :. J • - v O U y U V U E p cn v) U r J J J 61 •' U r O v ;� .. cz v U O z z U :n_ _ o Lo � I .9I U J • - /1 � I .9I I I I I F` J-� I D L-L-..JHK %./lKw 0: -6: 3-1300 OWNED(OPERATED BY Town of North Andover Of NORT1y OFFICE OF �? ybt • ED i 6.6tiC ` COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street * North Andover, Massachusetts 01845 °A;.Eo°" ��� SSgr uuS�I Memorandum To: Bob Nicetta, Building Inspector From: Kathleen Bradley Colwell, Town Planner 0)(— Date: - Date: March 20, 1996 Re: "Heritage at North Andover"- Sign The Planning Board has reviewed and approved the proposed sign for "Heritage at North Andover". The sign as approved will be 4' x 4', constructed of wood, with a white background, burgundy and green letters, and a burgundy border. The sign will be placed approximately 15' from the property line as shown on the attached site plan. If you have any questions or comments please let me know. cc. Gloria Walker BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 r'� Rl W F- cn < In ma o}%,raH V� W F— V) 11 AHIM MH .4 TOWN OF NORTH ANDOVER MASSACHUSETTS Y appeal of filing of :ce ie Office of i52 Town Clerk. NOTICE OF DECISION Date . ' ebruary28, 1994 . , January 4*, 1°94 Date of Hearin- January_ 18, 1994 February February 15, 1994 Petition of , ADS Senior Hous.:nc,..nc........................................ Premises affected . ,700 .Chicke= c Road ... .. .. . Referring to the above petaion for a special permit from the requirements of the . North Andover .Zonina By aw = .Sec on ,8..3 . � .Si :e _Plan .Review .. , ...... . so as to permit ,thE,cgnstruction.od.an.80,000.sq.ft.,.3.s ory,wood,f ame.building .... ... .. .. .. . . . . After a public hearing given on the above date, the Planning Board voted CONDITIONALLY to U"'RQY;......... the ..sTTE.P:�N.REVIEt:...................................... CC: Director of Public Works Building Inspector' Conservation Administrator Health Agent Assessors Police Chief Fire Chief Applicant Engineer File Interested Parties based upon the following conditions: Signed C.f . -%7,Q/t Richard A. Nardella, Chairman ................................ John Simons, vice Chairman ................................ Joseph.MahoneY:.Clerk.....,..... Richard Rowen ................................ JohnDaghlian .. 'Pianning * Board........ oard......, spaces as shown on the referenced "Revised Parking Plan 51 Spaces" dated 12/10/1993, rev. 1/31/1994. The parking needs of the facility shall be reviewed on an annual basis. If determined necessary by the Planning Board and the Board of Appeals the Expanded Parking Plan showing 100 spaces must be constructed. 9. The applicant/owner must make available, as part of the basic service package, scheduled private transportation for its residents to travel to local areas, to be arranged and scheduled through the management of the development. This service is necessary due to the reduction in the number of required parking spaces. 10. All signs within the project shall be of wood or stone, with uniform lettering and design. The signs shall in no way be interior illuminated (Neon or other means). All signs for this project must be reviewed and approved by the Planning Board. 11. No mechanical devices placed on the roof (ie: HVAC, vents, etc...) may be visible from any surrounding roadways. 12. The existing vegetative buffer between the project site and the adjacent Meadowview Condominium Complex must remain intact. Additional plantings may be required where the existing vegetation does not act as adequate buffer. 13. Any stockpiling of materials (dirt, wood, construction material etc.) must be reviewed and approved by the Planning Staff. Any approved piles must remain covered at all times to minimize any dust problems that may occur with adjacent properties. Any stock piles which will remain on site for more than one week must be fenced off and covered. 14. Any open excavation areas must be fenced off every night for the safety of the adjacent neighbors. 15. Any Plants, Trees or Shrubs that have been incorporated into the referenced Planting Plan approved in this decision, that die within one year from the date of planting shall be replaced by the owner. 16. The contractor shall contact Dig Safe at least 72 hours prior to commencing any excavation. 17. Gas, Telephone, Cable and Electric utilities shall be installed as specified by the respective utility companies. 18. All catch basins shall be protected and maintained with hay bales to prevent siltation into the drain lines during construction. 4 4 Location No. Date 1 lit-,= ff NORTH TOWN OF NORTH ANDOVE% p�4�ao ,a,'MO A Certificate of Occupancy $ �. Building/Frame Permit Fee $ Foundation Permit Fee $ ,- 4)the�r"Permit Fee $ (1tJU LM Sewer Connection Fee $ Water Connection Fee $ M TOTAL $ 50�- Bui ing Inspector 7954 Div. Public Works 7FPERMIT NO. V APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d40. LOT NO. 2 RECORD OF OWNERSHIP IDATE IBOOK 'PAGE ZONE SUB DIV. LOT NO. LOCATION ,_ 4 ,/ RPOSE DE7'S 7 CA%0+ 5©W�/Z 7- 7?L b,n / OWNER'S NAME OWNER'S ADDRESS/jo/ L r7 %419 57'1171;4�! ,T / STORIES SIZE BASEMENT OR SLAB ARCHITECT'S NAME( SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN , DIMENSIONS OF SILLS POSTS DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET 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 IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS �• gwOvlelA/I/,�V7if7l SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E 1'1' uy CA PERMIT GRANTED 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL # --Sb& --3 CONTR. TEL. # CONTR. LIC. # H.I.C. # - I S-� BUILDING RECORD 1 OCCUPANCY 12 r# ti SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE 3 1 2 13 CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER DRY WAIL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M TAREA _ '/. 1/1 1/ FIN. ATTIC AREA N_O B M T HEAD ROOM FIRE PLACES MODERN KITCHEN _ _ 4 WALLS II 9 FLOORS CLAPBOARDS B _ 1 22 J 3 _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARD"✓ D COMIAGN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. 6 FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR POOR ADEQUATE I� ONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13BATH 13 FIXE _ GAMBREL MANSARD TOILET RM. (2 FIX.) _ FIAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAD O B'M'T 2nd I —ELECTRIC NO HEATING I., 13rd I THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 4) CIA T-4 Cn UD cz 4� O w O A m YV) u C Z 0 Z acc = 7 o W C Z Z -o v co C O w ow d U uta w oA Q O pw,, Fz co Z a, w A w Q= z Ca • ui CL m m c CO 0 m c c N CD t 0 z O i Y 0o Q z CD E o W � q aot v co w oA Q Z Fz CL Q= z O •cmc C o_ W w O m m C � CD W � t� •- � v h ,i40 VD a m 'O 0:6 M H = F— A Z a O $ a.L.. m m m c CO 0 m c c N CD t 0 z O i Y 0o Q z CD E O i O O v co Z Q O D CO) — co cm z O C COD coLU �— .O y 'E O m m C/) z CL CD =CD O� C� O i 0 Q CL �a CO) C o Cc -0-0C Cc C CD Z C z CL V y C O C— c CL CO) z G z Qz J Ilk h] Date. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. �� �. .� ....� z.. r,1 ............... has permission for gas/ installation ... I% .Y. � ................ . in the buildings of .. ............................ at c .� `..�... �` �.... , North Andover, Mass. Fee. A.)' . 7 .�. . . GAS INSPECTOR f Check # 11% )- 4% 'Of' 8 2 4;;'82 MASSACHUSETTS UNIFORM (Print or Type) Building New ❑ Renovation \11 Z., TION FOR PERMIT TO DO GASFITTING Date OWC44 ?-?>— A- Permit # 2Y Uru6 _llut Owner's Name &AAN(AN %A Type of Occupancy � 124 004tilg L Replacement Y, Plans Submitted: Yes ❑ No y Installing Company Name Mt'a-f?acyl. PLW&N6j 9+ Address - D CA 2 L Business Telephone 4178, 425, VZM Name of Licensed Plumber or Gas Fitter Check one: Corporation ❑ Partnership F1 Firm/Co. Certificate # JIQo9 . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.' Yes 151 No ❑ If you have checked Yes, 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 permit application waives this requirement. Check one: — Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 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 installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Plumber Title _ I I Gasfitter Gtylrown I Master APPROVED (OFFICE USE ONLY) 3 Journeyman Signature of Licensed Plumber or Gas Fitter License Number 8"'? , CEO 01 ... ■■■■■■ ■■■■■■■■■■ :w... ■■■■■■■■■■■■■■■■■■MMM■■■■■ Installing Company Name Mt'a-f?acyl. PLW&N6j 9+ Address - D CA 2 L Business Telephone 4178, 425, VZM Name of Licensed Plumber or Gas Fitter Check one: Corporation ❑ Partnership F1 Firm/Co. Certificate # JIQo9 . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.' Yes 151 No ❑ If you have checked Yes, 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 permit application waives this requirement. Check one: — Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 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 installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Plumber Title _ I I Gasfitter Gtylrown I Master APPROVED (OFFICE USE ONLY) 3 Journeyman Signature of Licensed Plumber or Gas Fitter License Number 8"'? I Location ©� No. Date f NORTH ` TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ ss,��M„S tom, - Fou on Perm2ee $mitk e $ dJ` Sewer Connection Fee $ Water Connection Fee $ TOTAL $ cS 11 / i L/ J /�Set B ilding Inspector 7772 Div. Public Works PERMIT NO. 5077 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. f+ v all PAGE 1 MAP +40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE (BOOK PAGE 7p,IVE SUB DIV. LOT NO. ATION Tod C l' lal / * i uRPOSE yiG.B / g�'iYl��40 im!j1 ex F" O'WNER'S NAME ylwA�v ad� .r TSG. •^L/�! NO. OF STORIES SIZE d // OWNER'S ADDRESS 0, / 04 l,0,19 �ci ,v �i' BASEMENT OR SLAB NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD /�/� ;AR;C2HECT'S ILDER'S NAME C/'LaNa W G SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEO/ SIZE OF FOOTING X IS BUILDING ADDITION Y MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 JELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 7 4NS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DAT FI D «- 2' -( SIGN URE Oi?-OWN99 OR 4151 THORIZED AGENT F E E lr_� (X -w 4s PERMIT GRANTED d. 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. # 603' 3&Z' 12"30 CONTR. TEL. # CONTR. LIC. # ,-7-7 ,; `^ 1 OCCUPANCY MULTI. FAMILY_I �) OFFICES APARTMENTS I 11 HEATING WOOD JOIST CONSTRUCTION 2 FOUNDATION —I INTERIOR FINISH CONCRETE _8 PINE B I 2 13 CONCRETE BL K. BRICK OR STONE' RDW D PLASTER WOOD RAFTERS _ PIERS _ DRY WAIL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ 114 1/1 1/1 FIN. ATTIC AREA N_O B M T FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE EARTH HARDVJ D COMMON ASPH. TILE B _ 1 _ 22 ------ J 3 _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIORI� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP GAMBREL MANSARD FLAT I SHED BATH 13BATH 13 FIXE _ TOILET RM. 12 FIX.) _ WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. r �) TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURW TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. r ON x o a Q_ o w° u cn 94 O Go z 0 z o Cd LE :j w9' C U —coED w 94 O U W z ao C2 m w a O W U ,.a W MoD a w cn G w" a O H w 7 a�' C w W x w A w v w� o v �, cn Q o cnAI C C -m C O s ' O i i �ch o c �v CL c ev ev CD c =.o � L N Ea :mom CJ o c N O m cc `i 0 mCD C m C N 0 3 CO) CD m c_ c , � m '=C N R Ce m . C y m ; .=LSO = O Q N • Q�Ct V y O F. z C � O yd m C :neo o� Cc w o O �y '= e C E c,,vy vm.E O) CL 0-5 !W coi m H O t J- o. m Q S H MOD W H ac W H S E d N s y.r N 0 N C O cc 75 IM m Qf 'O m O Of C N CD O Z o g O b4' e► q m R 6 O co O GD O O v Z coCL O CO) G C � CD c CO2 co .� .y O O m m CD H t C = ca � O i O CD L m O a CL CM Q CO) C O � O O R CO.) J g .Q O D C Z CD CL V C c— .0 C d CO2 D J z LL z O a L1J U) Z O U APPEALS :1:' NORTH ANDOVER BUILDING DIVISION OF CONSERVATION HEALTHPLANNING &COMMUNITY DEVELOPMENT PL.-\NNING KAREN H.P. NELSON, DIRECTOR ....... Ma55aCt]t]56Sf5 O 184.5 (6 1 7) 68547'1 S In ace: rdance with the Provisions of MGL c 40, S 54, a condition of 002014 Permit Number '3gP-;' is that the debris resulting from this work shall be disnose d of in a prc-Eriv lice. d soiid waste disposal facility as defined by MGL c 111, S 150.•%. The debris will be disposed of in: N0711' 4 ',tic (WO -4 PAS ►�t� na A# 1 / (Loc:tidn of Faciiity) �Y-X 6-11ceNCA), / lko-z: J614 /V � W Ar a/1?F6 Signature of Pc.,,at Appiic: nt -_2 ` / Date oer_;t t : =_,.W _^e Town of North Andover must be �ro;ect .._cue^ t`.:e Of -"--:Ce of the 3u -'_d-: .. g :nspect_. DEMOLITION OF BUILDING AFFIDAVIT DATE?/,.? Iq 120 Main Street, 01845 (508)682-6483 az) DEPT. OF PUBLIC WORKS DEPARTMENT SIGN-OFFS'5. Z p� Z'- _Q - WATER-- - SEWER )EXTERMINATOR c5 11�76i /U 16jyk Z - - DUMPSTER - ON/0 STREET I U* ►P DIG SAFE NUMBER q113 3 3 d I M0 CABLE DATE RECD BLDG. INSPECTOR MORTIy Of KAREN H.P. NELSONr J]��� ...a ••y1'O p Town of L{%CC{{ Oi f NORTH ANDOVER BUILDING' gej�"°sit CONSERVATION DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT DEMOLITION OF BUILDING AFFIDAVIT DATE?/,.? Iq 120 Main Street, 01845 (508)682-6483 az) DEPT. OF PUBLIC WORKS DEPARTMENT SIGN-OFFS'5. Z p� Z'- _Q - WATER-- - SEWER )EXTERMINATOR c5 11�76i /U 16jyk Z - - DUMPSTER - ON/0 STREET I U* ►P DIG SAFE NUMBER q113 3 3 d I M0 CABLE DATE RECD BLDG. INSPECTOR