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Miscellaneous - 72 SUGARCANE LANE 4/30/2018
-fl Ftl) C) N O ■ N N C r) C) 0 C) A/ C) LL N U W O U 'w E Q Z O z a - O 0 O E O LL 0 z ~ 0 co C LL 0 O M 5 z a � � O U N <D Z > o O L) O C M � Q w v Z L 0 co 0 Q N E O O z U CMQ E m a C W O - Q E +J O Q C) co ko �. € 0 M Ali cu a) Q 01 04 Z N L tq to r, CN ~ • I- m J s, 0 0 N L Date ...... ....2.... ... ........... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. .................................................... has permission to perform ......... ........ ?:e ............ ...................... wiring in the building of ..... ( ....... ........................................................................... at ........... .. .............. ., �_orth ndoverM". Fee...!t..:. ( , -3224 ...... ........ . Lic. No . ................. . ..... 6 # .... . ........ ILEC INSPE Check# 12367 AA Commonwealth ®f Massachusetts Official Use Only - Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. i/07j (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRIC L WORK All work to be performed in accordance with the Massachusetts Electrical Code ), 527 C 12. 0 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 2; City or Town of. NORTH ANDOVER To the Inspector of ices: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 72 r- Aj Z Owner or Tenant 51 Telephone No. N Owner's Address Is this permit in conjunc ion w, it`h a build,*,er it? Yes � No ❑ (Check Appropriate Box) Purpose of Building �/'( r'%/� �C/� / \Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters !r77 Corrcnletinn nfthe fnllnwina tnhla mm, ho wni„oil h„ tho Tnc opm, of w;— No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA ' No. of Luminaire Outlets No. of Hot Tubs enerators KVA No. of Luminaires Swimming Pool Above❑ I rnd. n o 'Emergency Lighting iter 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 Pump Totals: Number Tons ...•.""'•"-..•.•••••. KW I ....................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances gay Security Systems:* No. of Devices or Equivalent No. of WaterKW 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 Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of 07res. 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 cov rage is m force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)/jdgCW1Q7S // I certify, cinder the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. LIC. NO.: Licensee: 449W -6e (, / Signature LIC. NO.: Z (Ifapplicab e, nter "ex t" ' e lic b //� Bus. Tel. No.: Address: �� /� �W�s��/t ®� �(Q 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 S required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. 4 Owner/Agent PERMIT FEE: $ �p ? Signature Telephone No: 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: 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 notification of completion of the work as required in M.G.L. c. 143, § 3L. responsible for the 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 Chanter 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: :B WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com y The Commonwealth of.Massachusetts , - Departmant of InclostriglAccMiks Office oflnvesiigations 604 Washington Street Boston, .MA 02111 www.mass govldla Workers' Compensation Insurance Affidavit: Builders/Cont°actorAleetricians fflhimbers A licant information Please Print Legibly Name (Business/Orgauization/Individual): Address: / / 45 City/State/Zip: 7f��,e4l, K Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1111 1 am a employer with 4. ❑ I am a general contractor and 1 6. [] New construction f employees (full and/or part-time).* 2 am a sole proprietor or partner have Hired the sub -contractors listed on the attached sheet. `!• E] Remodeling ship and`haveno.employees These sub -contractors have 8. ❑ Demolition worldng forme in any capacity. workers' comp. insurance. 9. Building addition [No workers' comp. jnsurance 5. ❑ We area corporation and its 10.] Electrical repairs or additions required.] 3.0 1 am a homeowner doing all work officers have exercised.their right of exemption per MGL II.[( Plumbing repairs or additions myself. EEO workers' comp. c.152, §I(4), andwehaveno I2.❑ Roofrepairs insurance reqalre4.] ed. employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box4f must also filloutthe section below showingtheir workers' compensation policy uiiormation. i Homeowners who submit this affidavit indicating they ate 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. f am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company N Policy # or S elf -ins. Lic. #: Expiration. Data: Job Site Address: City/State/Zip: Attach, a copy of the workers' compensationpolicy declaration page (showing the policy number and expiration date). failure to secure coverage.as requiredunder Section 25A ofMGL o. 152 can lead to the imposition of criminal penalties of a Em 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. Y do hereby cer1V under flee pains that tiie information provided above is ,,*4ue and Official use only. Do not write in this area, to be corampleted 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 U. Information and Instruetions - 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 ofhire,- 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 B61eg6ing engaged in a joint enterprise, and including the legal representatives of wdeceased employer,. or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 1%ever 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to tho contracting authority " Applicants Please fill. out the workers' compensailon affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(S) name(s), address(es) andphonenumber(s) along with their celtmcate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are notrequired to carry workers' compensation insurance. If au LLC or LLP does have employees, a policy is required. De advised thatthis affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. he 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 andprinted 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 thatrnust 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 stamp ed or marked by the city or town may be provided to the applicant as proof that a valid affidavitis on file for future permits or licenses. Anew affidavit must be filled 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 NOT required to complete this affidavit. The Office bf Investigations would like to thank you in advance for your cooperation and should you haveany questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: T'hoC.`ooxUweaTtj,ofMasSarhvses - Depaftent offndwWal .Accident Qfte o:1UnvoSizg Vous 6.00 Wmhhagtoa Sbx ;et Boston, UA 02111 . �'e�, # �X`����'��4.�QQ e� 4qC o.I? X-g��•:11�A��.�k'� - Revised 5-26-05 Fay, 617-727-7749 w waaagovIcha 0 I �"- f-'s North Andover MIMAP March 24, 2014 #220 ..:_:_fit_• �}I�i :: •,?. - :...: 'l _ : sslct :_:. 106.A -0205106:A-0198 lu :::_:.: •'yyJcc ::::- .�� :::_:._ `' " >�11! :: - ::Jct :r.::_ �U..::: `, ._...:::__ mj& ,Zile "r... ; :_•:•. .405:Cr0013 I , ... #13 1#271 #232 _i: 106:A-0204. :",:.,_, .. s�lti. •.:"• #235: -:- -•- -: :_::. •:• : - �mJtr..:_::_..; . ----- -- .... . -..alp .:: _•. ••:::_: 106.A-0203 ::::._L(t:::_:. _?J[� ::__- 'alt �... _=.:' ' :_: •1! .. ._:_ ._.. #263 `y_:Jtr _;� .`y- s�ltr <. ,eSti�c r 106.A:0300Ju 106.A-0234 #246 `l+� -.:_ ::-',}lr�'-y:_. _..'zbc` 106.A-0201#240 . _ W 106.A-0202 ..... ,..i, .:.._..Of4'•�J,cr.::i=•:'; #260 flu : '' = :i''�i •`�': mitt'"'::r' 1u ':'•:: �*e.:: lO5.0-0079 106.A -0245106.A-'0234:... #280; #30 106.A-0246 �G #40; {�H I-:.-:. s 'rii:_i; I .:-:Jrr;I; •:='- �I ti ::" auk ..g, Wk ... � ' e; 106.A-0237 ' I 4t, I I, #17 tte #56 __ :... . - -Sl 106:A-0243 • SO/ :_ ti maJtr 106.A-0241 ' _ a3tte Ah #31 ��I ; J(c #45 i06:A-023 Jc106.A-0242 x R1 #64 t d I, 106.A-0240 '•r te kwJtr 106.A-0244 #65,=,#�1=10sit� ulu ' mlv err . _ 11 106.A-0239 #72 t• ' - ` mJu � l ik aa& 106.A-0225 #77' #60- .. . '%Lcr _.art 106.A-0224 #87 106.A-0266 #84 106:A-0261_-:_ ikltc':: #66t m t: '' ' vttr10,65 U260 #96 106.A-0267 #93, - 106.A -0262106.A-0265 106.AA223 1066A-0263 air - #102 106.A-0128 #99 :. :.._.. 106.A-0264 _ at • _ . MA -0220 WSJ �Uu Batu 4060AM DA3}?� . :. 105.0-0016 — Rail Line ``-;u Wetlands Zoning - - - Interstates 0 Exempt Lands {7 Bu— !1 Busine s 1 Dislnct - s 2 Di net - - - Hon—tal Datum: MA Staleplane Coordinate System, Datum NAD83, _ l .— SR O Busine 0 Busine — Roads 0 Genera Ci Easements - 0. Planne - 93 Corrido s 3 District --. s 4 District NORTN - - Business District Of o q� Commercial Dev 4 ,, Y -s �° O Development Dist a _ p Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of Environmental Affairs/MassGIS. The information depicted on this map is It be for legal boundary C3 MVPC Boundary - 0 Corrido Q Municipal Boundary � 0 Corrido 3 L Development Dist O to � Development Dist �' —.. 9 for planning purposes only. may not adequate - dein bon or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING 1 - - $: Industn 1 District THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY Zoning Overlay, BAdult Entertainment - 0 Industn 2 District + q e i OF THESE DATA THE TOWN OF NORTH ANDOVER DOES NOT Downtown Overlay District - - 0 Industn 13 District ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Ind ustn 0 Historic District :Reside I S District eel District '� qO�+��o �,y� THIS INFORMATION - - - _ ®Water Protection 0 Reside ce 2 District 'SAC NUS O Parcels - bl. Reside ce 3 District IC Hydrographic Features de 1" = 227 ft de --- Streams -ede -4 District ce s Distri - ���age ce 6 District esidential District - 0 4 Date ...... ..-... �� TOWN.OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...............hz..&t...... L—Z! C................................ has permission to perform ...... ... ..I.e Tq �.�—�/�'t� . wiring in the building of ............... ,at ........................................... .... , North Andover, Mass. � 7 �-3 8 Fee: h� ,�-r --:.. Lic. No .................. ...............kLEcTRicALNspwTr,17..1'/ . .................. L - V. Check # S6 S-2- 11944 Commonwealth ®f Massachusetts Department ®f Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Gi _ 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 Code (ME ), 527 MR 12.00 (PLEASE PRINT ININK OR TYPE ALL )NFORMATIOA9 Date: %Q City or Town of: NORTH ANDOVER To the Inspe for f Wires: By this application the undersigned gives notice of his or her intentMtl-jnn, erform the electrical work described below. Location (Street & Number)_ #7 2 S a� e, Q . u� Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Ys [k Purpose of Building ,� wft llh Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service 17U/ Zff Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:,evlol Undgrd No. of Meters Undgrd ❑ No. of Meters 0 UV CriYa ! fid A4kdG07 S ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans v No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires y Swimming Pool Above ❑ In- Elo, rnd. rnd. o meLighting Battery Units No. of Receptacle Outlets C/P No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. I 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: Numberns To 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 XW SecuritNo. o De ices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H Hydromassage Bathtubs 3' g No. of Motors Total HP Telecommunications Wiring: No. of Devices or Eg uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrl al Work: �p 000 dU (When required by municipal policy.) Work to Start: %0 j b /3 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO GE: 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 ;6r its substantial equivalent. The undersigned certifies that such cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE V BOND ❑ OTHER ❑ (Specify:) Icertify, under thepains and penalties o perjury]j that the information on this application is true and complete. FIRM NAME:. ,� G /h c:. LIC. NO.: 17 30 7 Licensee:C11,1/5 Signature LIC. NO.: (Ifapplicable, enter "exempt 11 in the Iic nse narmb r line.) Bus. Tel. No.-9�" JZZ- loo I Address: 7-73 � G 11 /7 Alt. Tel. No.:f7k- 30Z- Z/87 *Per M.G.L c. 147, s. 57-61, se rity 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. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: 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 R—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed 0 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 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: ti Pass Failed Re- Inspection Required ($.) ❑ Inspectors Com ents: Inspectors Signatur Date: FLXAI., Legs AION: Pass P1 !S0,4 Failed 1fl Re- Inspection Required ($.) ❑ I nspectors Comments: .� Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts - Department oflndustriglAccidents 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/Xndividual): fir -t( aulil^L, Lix Address: -n-3 City/State/Zip:"�'f l/► , Phone #: 1 3 % 2 l6 U Are Vft an employer? Check the appropriate box: - 1. I am a employer with —3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have }fired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required.] officers have exercised their 3. ❑ I am a homeowner, doing allwork right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), andwehaveno insurance required.] 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 #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they Ere doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. X am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. - „ , 2 n Insurance Company Name:. L h5, , Policy # or Self -ins. Lie. M b) 6 A .L D 3 Z6 yD ExpirationDate: �/(p Job Site Address: —C City/State/Zip: Attach a copy of the workers' c mpensation 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 eine up to $1,500.00 and/or one-year imprisonment, as wellas 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cerfify under thepains.,andAenaWes ofperjury that the information provided above is true and correct. I s 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 ofhire, 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. B e 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 whichwill 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. Anew affidavit must be filled out each year. Where a homeowner 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 ofMassarliuse"W9 Depafteat offadustrial .Accidents ofaicc o�Iuvesfzgations 600 Washingtoaa. Stxoet Boston MA 02111, TO, # 61.7-727-4900 oxt 406 ox 1-877-MASSAFF, Revised 5-26-05 Fax# 617"727-7749 VV1WW_macc anizfri;a - -L2LL P- This certifies that ... ....'. ` �^ haspermission �'i�� t�T t' lel ►'1 Mom to perform .... F .... .................. . plumbing in the buildings of. . U 9:...^ ..................... . at .. . �-T7* . .. "" . ... , North Andover, Mass. Fee. I(4:1�� Lic. No...t� .4... �................... .. . PLUMBING INSPECTOR Check #IVB - M MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY `V0 fi Au do if_(/ MA. DATE PERMIT # JOBSITE ADDRESS �� S' (/ (�(� p Laa412WNER'S NAME C CJV L j POWNER to ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL-❑ EDUCATIONAL ❑ RESIDENTIAL [g - PRINT NEW: ❑ RENOVATION: [L]' REPLACEMENT: ❑ . PLANS SUBMITTED: YES ❑ NO ElCLEARLY FIXTURES T FLOOR- BSMT 1 2 3 4 5 6 __7__T__879 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY Ll ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TQILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which, meets the requirements of MGL Ch. 142. Yes Gg,'No ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ey 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 BOX ONLY: OWNER ❑ AGENT ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all . plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massach/us/e State Plumbing Code and Chapter 142 of the General Laws. a �C ! VI PLUMBER NAME r i &(A i is `!ii SIGNATURE LIC # MP [j' JP ❑ CORPORATION- [0#__1"3 PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME Mp (rJ ig4� .In v�� ADDRESS: � � l �1(� � T V''c rP T - `1. CITY �.� L ��lSTATEy % ZIP C21 EMAIL % V l Vt Z) Ve-- V 12 &1, 1,7 r li 7�%t°t /P TEL / ! �— L� _ 1270 CELL �9-3 FAX M e O d�1 x b r u v V z z o - a m � U3 D D � .d r z m O ca � b t� _ m t� z m O w til ❑tD N O z ❑o r r� a O z z 0 a r� C1VIMNaIVEALTH Of MASSACSET .� _�...,. . ... ....z. .. •_ t UII�IBERS ANDGASFIfiTE'PENS h +i x►S A �OURNEYMW E r ��� I UES TIdE A96\fE���10ENSe T I * 6 8AR�7LEY't ST«f MA!l' EL=DA �1118¢T��1 Y Date ....... NORTIy o= TOWN OF NORTH ANDOVER ti F • PERMIT FOR -OAS INSTALLATION y 'ISS CH R This certifies that .Y,4!?1'e.!.'.r@ �' !� el/? fAr^-� has permission for gas installation .. " ..Z. .. in. the buildings of. 4n..ar...�.. . Ae at .�? . .. . ... . North Andover, Mass. Fee �-�4F. Lic. No. -�� . ..... ,y"�! ... GAS INSPECTOR Check 80*15 GtY`rtIt7�C - MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING + Citylrown: /3A/Z)6 OL , MA. Date: f� t5 � Permit# Building Location: -72 S U6,'P Q9Ai LN Owners Name: _j ()14 v . CUK-T '/ P'J f Type of Occupancy: Commercial ❑ Educational ❑ industrial ❑ Institutional ❑ Residential [ t - 0 New: 011" Alteration: ❑ Renovation: [?-"'Replacement: ❑ Plans Submitted: Yes ❑ No ❑ GtY`rtIt7�C - INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalentwhich meets the requirements of MGL. Ch. 1422 Yes �o ❑ !f y!+u have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability Insurance poNcy ❑� Other type of indemnity ❑ BondLi OWNER'S INSURANCE WAIVER; I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's A ent By checking this box ; I hereby certify. thatail 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 erformed under e' ermit Issued for this application will be In compliance with all Pertinent provision of the Massachusetts. State Ptumbingl de nd Chapter 14 of th General Laws. Type` of License: By CO Plumber - Title Gas FI tter^ g . Plumber/Gas Fitter ❑ Mast Si ature :of Licensed lu . s y.. ._. ❑Jourfl .. - � . J Master eyman �! r ~tif Cnyrrown License Number: APPROVED OFFICE USE ONLY)❑ LP installer ESTIMATF.0 COST OF JOB lY W + a Q 0 m 0 t - 0 w x w Luu a to Z E-- 1-- O Cr W Rid2 h tom- _ M 0 0 cc Mb 1--• _ ^�? �z a` •:: 3 f 0 .'tic QN'LLI U cn d y T U11 a IX m>° z O Q W z Z 1X s 0 W�z Q ,� O 10 g a o W z z y a - U :O 0_ x O a Fes- z 0' SUB SUB BSMT. BASEMENT 1 FLOOR 2. FLOOR 3 FLOOR 4 FLOOR 5" .FLOOR 6: FLOOR w 7 FLOOR 8'H FLOOR T .:r °- �:Check C•,�. ��;1� �T<:L-'i �!'�:�; One Onty Certificate # Installing .Company. Name: >y � •� f� -�f�� ,�/v�C.. �/1 Address; 740 , t � 1 N clrylTown: . t),oL 16 3 state: > > 1 w . ❑ Corporation.' _ ❑ Partnership Business Tel., ��7-7 1 b a l Fax: '7)17 -?7) ✓�`g� p Name of Licensed Plumber/Gas Fitter. &Z 6- V/ ".-Z 9 Firmrcornpany INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalentwhich meets the requirements of MGL. Ch. 1422 Yes �o ❑ !f y!+u have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability Insurance poNcy ❑� Other type of indemnity ❑ BondLi OWNER'S INSURANCE WAIVER; I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's A ent By checking this box ; I hereby certify. thatail 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 erformed under e' ermit Issued for this application will be In compliance with all Pertinent provision of the Massachusetts. State Ptumbingl de nd Chapter 14 of th General Laws. Type` of License: By CO Plumber - Title Gas FI tter^ g . Plumber/Gas Fitter ❑ Mast Si ature :of Licensed lu . s y.. ._. ❑Jourfl .. - � . J Master eyman �! r ~tif Cnyrrown License Number: APPROVED OFFICE USE ONLY)❑ LP installer ESTIMATF.0 COST OF JOB The Commonwealth of Massachusetts Print Farm Department -of Industrial Accidents Office of Investigations I Congress Street, Suite100 Boston, MA 42114-2017 www.tuass govldia Workers? Compensation Insurance Affidavit: Builders/Contractors/Electricians]Plumbers Applicant Information Please Print Le i6l Name (Business/Organization/Individual): B V` E. F Address: f C� v t,+ �' J I: S City/State/Zip: 01 Phone: #: L7 Are you an employer? Check the appropriate box: Type of project (required): Z. [am a employer with l 4• ❑ I am a general contractor and I have hired the sub -contractors 6. ❑ New construction employees (full and/or part -Limey. 2. ❑ I am a sole proprietor or partner: listed on the attached sheet. 7. ,[J Remodeling ship and have no employees These sub -contractors have g• E] Demolition employees and have workers' 'working forme in any capacity. 4. ❑Building addition comp. insurance.1 eq workers comp. trtsutartce- 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its � 3. ❑ 1 am a homeowner doing all work officers have exercised their I Ln Plumbing .repairs or additions myself. [No workers right of exemption per MGL comp. 12.0 Roof repairs c. 152, § 1(4), and we have no t u , insurance required.] t 13.[2'Other i S employees. [No workers' Q comp. insurance required.] 1 �t=� 7-1 N *Any applicant that checks box #] 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. iContractors.that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. ,If the sub -contractors have employees, they mustprovide their workers'.comp. policy number. I am an employer that is providing workers' compensation insurance for my employees: Below is thepolicy and job site information. Insurance Company Name Policy # or Self -ins. Lie. #: € T o Expiration Date: Job Site Address: City/State/Zip:AI ! 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-yearimprsormert, 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 maybe forwarded' the-OffcP of Investigations of the D r insurance coverage verification. I do hereby certify uWder.4 pains ialgp ofpqrjyry that the information provided ab ve is true and correct.. C�.��°�✓ signature: pp C - Date: Q Phone ,#: `? _ _ +�r f / Official use only. Do not write in this area, to be completed by city or torten official City or'ruwu: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityfrown Clerk 4. Electrical Inspector 5. Plums hin,g Inspector 6. Other Contact Person: Phone #:_� 97s4 Date ...... /.�1... x'...1.0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......1 .A/Z has permission to perform ........tr .....ca j ......................... wiring in the building of ........................`U...................................... at .......:2 ........J`�! /°..Cr r `... �- ........ , North Andover, Mass. Fee 4✓5..... Lic. No.. ................ .. . rx,_ i Check # -� O ELECTRICAL INSPECTOR (fomtnontueahk o/ ///am.4uJetti mmeLJePartment oI Jire service, r BOARD OF FIRE PREVENTION REGULATIONS Oficial Use Only Permit No. 7/1Z Z 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 PLkK OR TYPE ALL MFORMATIOA9 Date: �" 6 City o own : L� Atzi 1W To the Insp ctor of Wires: By this applicatio e rsigned gives notice of his or her intention to perform the electrical work described below. Location (Street .& Owner or Tenant Owner's Address 54me Is this permit in conjunction with a building permit? Yes ❑ No ,[4 (Check Appropriate Box) Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ Completion ofthe `fTllnwinv tnhl,, No. of Meters No. of Meters ho wni"'d by tho 1-- y— -'W" 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- El rnd. rnd. o Emergency Lighting Batte 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 Alerting No. of Devices g No. of Waste Disposers Heat Pump Totals: Number Tons f- - ---------- -- KW -- ----- ------------- No. of Self -Contained Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Lo Munici al r ec No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Imo' Heaters No. of No. of 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 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:) Self Insured I certify, under4he pains and penalties of perjury, that the information on this application is true and complete_ FH mmw: ADT.5ecurity Services Inc. LIC. NO.: C-45 Licensee: Mark A. Brophy Signature- - LIC. NO.: C-45 (If applicable, enter "exempt"in the license number line.) Bus. Tel. No.: 978-657-0443 Address: 155 West Street; Suite 6 Wilmington NIA 01887 Alt. Tel. No.: *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. PERMIT T'EE: $ m 1-4 id 410.10 Article 410 • Luminaires, Lampholders, and Lamps (B) Corrosive Locations. Luminaires installed in corro- sive locations shall be of a type suitable for such locations. (C) In Ducts or Hoods. Luminaires shall be permitted to be installed in commercial cooking hoods where all of the following conditions are met: (l) The luminaire shall be identified for use within com- mercial cooking hoods and installed such that the tem- perature limits of the materials used are not exceeded. (2) The luminaire shall be constructed so that all exhaust vapors, grease, oil, or cooking vapors are excluded from the lamp and wiring compartment. Diffusers shall be re- sistant to thermal shock. (3) Parts of the luminaire exposed within the hood shall be corrosion resistant or protected against corrosion, and the surface shall be smooth so as not to collect deposits and to facilitate cleaning. (4) Wiring methods and materials supplying the luminaire(s) shall not be exposed within the cooking hood. Informational Note: See 1 10.11 for conductors and equip- ment exposed to deteriorating agents. The requirement in 410.10(0)(4) was initially taken from NFPA 96, Standard for Ventilation Control and Fire Protec- tion of Commercial Cooking Operations. NFPA 96 provides the minimum fire safety requirements (preventive and opera- tive) related to the design, installation, operation, inspection, and maintenance of all public and private cooking opera- tions, except in single-family residential dwellings. NFPA 96 covers residential cooking equipment where used for purposes other than residential family use — such as employee kitchens or break areas and church and meeting hall kitchens — regardless of frequency of use. Grease may cause the deterioration of conductor insula- tion, resulting in short circuits or ground faults in wiring, hence the requirement prohibiting wiring methods and mate- rials (raceways, cables, lampholders) within ducts or hoods. Conventional enclosed and gasketed-type luminaires located in the path of travel of exhaust products are not permitted because a fire could result from the high temperatures on grease -coated glass bowls or globes enclosing the lamps. Recessed or surface gasketed-type luminaires intended for location within hoods must be identified as suitable for the specific purpose and should be installed with the required clearances maintained. Note that wiring systems, including rigid metal conduit, are not permitted to be run exposed within the cooking hood. For further information, refer to UL 710, Standard for Safety for Exhaust Hoods for Commercial Cooking Equip- ment. 552 (D) Bathtub and Shower Areas. No parts of ci connected luminaires, chain-, cable-, or cord-suspende( minaires, lighting track, pendants, or ceiling-suspen (paddle) fans shall be located within a zone measured mm (3 ft) horizontally and 2.5 m (8 ft) vertically from top of the bathtub rim or shower stall threshold. This zor all encompassing and includes the space directly over tub or shower stall. Luminaires located within the actual side dimension of the bathtub or shower to a height of 2. (8 ft) vertically from the top of the bathtub rim or sho threshold shall be marked for damp locations, or marked wet locations where subject to shower spray. The last sentence of 410.10(D) clarifies that secur( tened luminaires installed in or on the ceiling or w permitted to be located in the bathtub or shower area. they are subject to shower spray, the luminaires n listed for a wet location. Luminaires installed in the shower zone and not subject to shower spray are requ be listed for use in a damp location. GFCI protectia quired only where specified in the installation instn for the luminaire. The intent of 410.10(D) is to keep cord -coni chain -hanging, or pendant luminaires and suspende out of the reach of an individual standing on a bathtc The list of prohibited items recognizes that the same electric shock is present for each one. Exhibit 410.1 illustrates the restricted zone in wli Restricted zone I Surface=ii or recess+ luminaae, (acceptati or above I Securely mounted wall luminaire, t3 ft permitted - *r s n EXHIBIT 410.1 Luminaires, lighting track,,and dle) fan located near a bathtub. 2011 National Electrical Code wtliun= zone►;. - ter, thtub and Shower Zone (continued) ........................................................................................................................... Q, Recessed lights, surface- tn4unted lights, and exhaust fans are; permitted within the bathtub zone. Exposed metal parts must be grounded in accordance with 2.50.110. I'Chain-, cable-, or cord - suspended luminaires (lighting fixtures), cord -connected lumi- naires (lighting fixtures), lighting track, pendants, and ceiling-sus- peoded (paddle) fans are permitted Aoutside the zone. ION A receptacle shall 'nstalled within or over the bathtub or stall >>406.8(Q<4. ® The bathtub zone measures 3 ft (900 mm) horizontally and 8 ft (2.5 m) vertically from the top of the bathtub rim or shower stall threshold. The zone is all encom- passing and includes the area directly over the tub or shower stall ),N 410.4(D) «. e Receptacles .............................................................. ..................... If»ai�age " tb6.�t 3tedZone a duplex receptacle is installed, GFCI protection is ed. If a single receptacle is installed for an appliance, protection is not required »21O.8(A)(2) Exception t :Laundry equipment receptacles are not counted as required garage receptacles )>21O.52(G)«. @.At least one receptacle is required in an attached garage >)210.52(G)(C (Receptacle placement is not determined by UI ;Receptacles not readily accessible do not require GFCI protection ))21O.8(A)(2) Exception No. 1 «. ©1AII receptacles installed in garages must have GFCI pro -taction unless installed under one of the exceptions found in 210:8(A)(2). if a duplex receptacle is installed for two appliances, GFCI protection is not required. The two appliances must be cord 1 and plug connected and must be located within a dedicated t space where in normal use they are not easily moved from one place to another >>21O.8(A)(2) Exception No. 2<<. .Non-GFCI protected receptacles installed by an exception found in 21O.8(A)(2) do not count toward the one garage -xEiptade requirement >> 21O.8(A)(2) <<. �Asingle receptacle installed on a 20 -ampere branch circuit must have a rating of 20 amperes >) 210.21(8)(1) «. Unit 7. Specific Provisions 129 .' k Dryer washer U Sump Pump GFCI Garage Receptacle Located in Ceiling GFCI Protected a n m 128 SECTION 2: ONE -FAMILY DWELLINGS Bathroom ................................................................................................ ID A branch circuit providing power to a bath- room receptacle may also provide power to other bathroom receptacles, whether in the same bath- room or in different bathrooms )) 210.11(C)(3) ((. Q A branch circuit providing power to a bath- room receptacle may also provide power to other equipment, such as lighting and exhaust fans, but only within the same bathroom >>210.11(C)(3) Exception((. If the branch circuit provides power to a bathroom receptacle and other equipment, the circuit cannot provide power to any other bathroom. ® A branch circuit providing power to bath- room receptacles cannot provide power to any receptacle or lighting outside of bathrooms >) 210.11(C)(3) <(. Bath n 27mpere " To Other Overcurrent GFCI Receptacles Device Protected in Same Bathroom Bath —� ; ` 20 -ampere To Receptacles Overcurrent GFCI in Other Device Protected Bathrooms Bath 20 -ampere To Other To Receptacles Overcurrent GFCI Receptacles in Other Device Protected in Same Bathrooms Bathroom Bathtub and Shower Zone ID Luminaire (lighting fixture) permitted (not in zone) Luminaire (lighting fixture) not permitted ® No parts of cord -connected luminaires (lighting fixtures), chain-, cable-, or cord -suspended luminaires (lighting fix- tures), lighting track, pendants, and ceiling -suspended (pad- dle) fans are not permitted within a certain zone of a bathtub )�Ml O (D) (<. The bathtub zone measures 3 ft (900 mm) horizontally and 8 ft (2.5 m) vertically from the top of the bathtub rim or shower stall threshold and includes the area directly over the tub. Bath --I 20 -ampere To Equipment Overcurrent GFCI in Same Device Protected Bathroom Bath 20 -ampere �` To Equipmentt To Other Overcurrent GFCIin Same athrooms Device Protected Bathroom Bath 20 -ampere To Receptacles TO quipme t Overcurrent GFCI in Other ' in O#her Device Protected Bathrooms ; athro Bath I) 20-ampere " (�Io:Qa rage Overcurrent GFCI r Oli�door Device Protected eceptacl Bath 20 -ampere CS :hinOvercurrent GFCI Device Protected ms Article 410 • Luminaires, Lampholders, and Lamps minaires, lighting track, and paddle fans are pro- s requirement applies to hydromassage bathtubs, in 680.2, as well as other bathtub types and is. See 680.43 for installation requirements for t tubs (as defined in 680.2) installed indoors. tinaires in Indoor Sports, Mixed -Use, and All - Facilities. Luminaires subject to physical damage, nercury vapor or metal halide lamp, installed in nd spectator seating areas of indoor sports, mixed - I -purpose facilities shall be of the type that protects with a glass or plastic lens. Such luminaires shall led to have an additional guard. f accidental breakage of mercury or metal halide jackets in open luminaires have occurred in ities and other similar locations. If the lamp is ;lass shards can fall on players or spectators. If le is damaged, the arc tube continues to operate h the outer jacket may be cracked or missing. n requires luminaires to have their lamps pro - glass or plastic lens, and it also permits an addi- ctive guard over the lens'cover. Luminaires Near Combustible Material res shall be constructed, installed, or equipped with r guards so that combustible material is not sub - temperatures in excess of 90°C (194°F). ments of 410.11, 410.12, 410.14, and 410.16 placement of luminaires near combustible mate - they do not become a heat source that could ig- source. Tests have shown that hot particles from ndescent lamps can ignite combustibles below Z Luminaires over Combustible Material folders installed over highly combustible material e of the unswitched type. Unless an individual switch Tided for each luminaire, lampholders shall be located t 2.5 in (8 ft) above the floor or shall be located or !d so that the lamps cannot be readily removed or ed. `,.4.10.12 refers to pendants and fixed lighting equip - stalled above highly combustible material. If a lamp be located out of reach, the requirement can be met Aping the lamp with a suitable guard. Section 410.12 'Oply to portable lamps. V 41014 Luminaires in Show Windows 410.16 Chain -supported luminaires used in a show window shall be permitted to be externally wired. No other externally wired luminaires shall be used. 410.16 Luminaires in Clothes Closets (A) Luminaire Types Permitted. Only luminaires of the following types shall be permitted in a closet: (1) Surface -mounted or recessed incandescent or LED lu- minaires with completely enclosed light sources (2) Surface -mounted or recessed fluorescent luminaires (3) Surface -mounted fluorescent or LED luminaires identi- fied as suitable for installation within the closet storage - space According to 410.16(A)(3), LED lighting, a new technology with a very low heat source, is permitted in clothes closets if listed for closet use. (B) Luminaire Types Not Permitted. Incandescent lumi- naires with open or partially enclosed lamps and pendant luminaires or lampholders shall not be permitted_ See the commentary following 410.16(C)(3). (C) Location. The minimum clearance between luminaires installed in clothes closets and the nearest point of a closet storage space shall be as follows: (1) 300 mm (12 in.) for surface -mounted incandescent or LED luminaires with a completely enclosed light source installed on the wall above the door or on the ceiling. (2) 150 mm (6 in.) for surface -mounted fluorescent lumi- naires installed on the wall above the door or on the ceiling. (3) 150 mm (6 in.) for recessed incandescent or LED lumi- naires with a completely enclosed light source installed in the wall or the ceiling. The requirement of 410.16(C)(3) results from tests that have shown that a hot filament falling from a broken incandescent lamp can ignite combustible material below the luminaire in which the lamp is installed. (4) 150 mm (6 in.) for recessed fluorescent luminaires in- stalled in the wall or the ceiling. (5) Surface -mounted fluorescent or LED luminaires shall be permitted to be installed within the closet storage space where identified for this use. Electrical Code Handbook 2011 553 8 7 4*7 Date. Po . r= •sof "oR, :�h TOWN OF NORTH ANDOVER ' PERMIT FOR PLU BING �ss�cHus� t _ ff This certifies that ...� q.... -�' 4� has permission to perform plumbing in the buildings of f. j��.....(.:(<� �� ! . `r,........ . at /`....... "' s '. -t........ North Andover, Mass, PLUMBING INSPECTOR Check,q t j q FIXTIIRFS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: A MA. Date: 11-3-10 Permit# Building Location: Owners Name: Type of -Occupancy: Commercial ❑ Educational ❑ Industrial ❑ —Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: Replacement: ❑ Plans Submitted: Yes ❑ No FIXTIIRFS 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 Yes, please indicate the type of coverage by checking the appropriate box h -low. A liability insurance policy 21 Other -type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Aaent l.hereby certify that all of the details and information I have -submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed.under the permit issued for this application will, be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter_IA24ff the General Laws. By Type oft.icense: Title ❑ Plumber Sfgnat a itensed Plumber cnyrrown ® Master License Number: 8678 eennnvcn incciec i ice AM V% ❑Journeyman Z Y O V C9 a z Q Q { z OCO) J x co Q W ' G a Q LU Q rn z �.. .0 & . � � Z vi WILL. t:7 z v i- ac' u ddW�dd to = 0 N- ?� UJ0 = Z Q W d Z f11 hW- uJ W g a m m o c W 0= Y (a fn i- _5 3 3 3 0 SUB BSMT. BASEMENT .15T FLOOR 2NO FLOOR 3 FLOOR 41N FLOOR $7 FLOOR 6 FLOOR a FLOOR 8 FLOOR Chf:@fit Ofie Onl"jr Cefitificate # Installing Company Name: Uptack Plumbing & Heating,. Inc. M Corporation 1415 Address: 32 Rochambault Cltyrrowrr:Have rhill State: MA ❑ Partnership Business Tel: 978 372-85:03 Fax: 978 521-1438 ❑ Firm/Company Name of Ucensed Plumber: Leonard A. Hall 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 Yes, please indicate the type of coverage by checking the appropriate box h -low. A liability insurance policy 21 Other -type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Aaent l.hereby certify that all of the details and information I have -submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed.under the permit issued for this application will, be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter_IA24ff the General Laws. By Type oft.icense: Title ❑ Plumber Sfgnat a itensed Plumber cnyrrown ® Master License Number: 8678 eennnvcn incciec i ice AM V% ❑Journeyman 9670 Date... ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that.................................................................................. has permission to perform ` ................./:..... .......................................... wiring in the building of ...... jIZ4"? .......... ............................. at .............. AA0 ...... ..... ,North Andover, Mass. ..... Lic. ........ ... LEcTRI AL INSPECTOR Check # /Z- / >I-- TAM a,vrsi111ulluvt7asameff aau nvicIzo., nBaa�c�aa� 57,M1,17 LZ j BOARD OF FIRE PREVENTION REGULATIONS Permit No. z k2 70 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 (NEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: ? " z r-10 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) Owner or Tenant k h Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes F�_;�No ❑ (Check Appropriate Box) Purpose of Building A e Utility Authorization No. Existing Service 1?9 Amps 20 o Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:' Undgrd 0No. of Meters __1j_ Undgrd ❑ No. of Meters i'nrv, n!etfon nftho fnllnwinu table may be waived by the Inspector of Wires. -Attach additional detail V desired, or as required by me inspector uj rr LT GJ. Estimated Value of Ylectrical Work: 7yU (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VERAGE: 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: /zap LIC. NO.: a g29',14 Licensee: SignatureLIC. NO.: 2cSZ 2 2 (If applicable, enter "exempt" in the icense nu er line.) Sus. Tel. No.: Address: 1BJ ` ° Alt. Tel. No.: *Per M.G.L c. 147, s. 57- 1, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE V�AIVER: 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 Owner/Agent PERMIT FEE: $ Signature Telephone No. T otal No. of Recessed Luminaires No. of Ceil:P• (Paddle) addle ) Fans sformers KVA Transformers s No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. rnd. o. o mergency ig ing Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection andInitiating No. of Switches 07No. of Gas Burners Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers P Totals: ................ Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Other Local ❑ Connection ❑ No. of Dryers y Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of WaterKW No. of -No. of Data Wiring: Heaters Si ns Ballasts No. of Devices or Equivalent Telecommunications Wiring: Hydromassage Bathtubs No. H y g No. of Motors Total HP No. of Devices or E uivalent OTHER: -Attach additional detail V desired, or as required by me inspector uj rr LT GJ. Estimated Value of Ylectrical Work: 7yU (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VERAGE: 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: /zap LIC. NO.: a g29',14 Licensee: SignatureLIC. NO.: 2cSZ 2 2 (If applicable, enter "exempt" in the icense nu er line.) Sus. Tel. No.: Address: 1BJ ` ° Alt. Tel. No.: *Per M.G.L c. 147, s. 57- 1, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE V�AIVER: 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 Owner/Agent PERMIT FEE: $ Signature Telephone No. CJs e-,- //.? 'r ,C'_7 f // �.1 The Commonwealth of Massachusetts Department of Industrial. Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ak s• • www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/]Electricians/Plumbers Applicant Information j Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: � ,rr � ®/ Jr z/o Phone #: q2 Y Are yo n employer? Check the appropriate box: 1. a employer with 2- 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. # 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 41 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. Lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. . 7 . Insurance Company Policy # or Self -ins. Lic. M 1?T W C' q 0 J% S Q Expiration Date:. Job Site Address: %-2 xfUp A,- LC:!'1 C �---� r1 C City/State/Zip: QGl 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 DJAfor insurance coverage)verification. I do hereby Phone #: ?rti ut he pain id pe ties of perjury that the information provided above is true and correct. Date: ?- ;2- 1( S" lv Y- el 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 #: Date. ......... 3�0<<,..o 0 \L TOWN OF NORTH ANDOVER O D PERMIT FOR GAS INSTALLATION �,SSACHUSE� I This certifies that ....4,Z -714.).c. Ar has permission for gas installation ...,fes`? y{ .............. in the buildings of .... ........................... at ..7 ? .::5 ....... , North Andover, Mass. Fee.. �� Lic. No.. K ?).... . �L_ ? .��;—(GAS INSPR Check # .2 7'i 51 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: //- , MA. Date: 3--4 �'�® Permit# Building Location: % d u -114,l Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential 12 - New: ❑ Alteration: ❑Renovation: ❑ Replacement: [ Plans Submitted: Yes ❑ No E�, FIYTI IRFS INSURANCE COVERAGE: 1 have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes.® No.B If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S. INSURANCE. WAIVER: I am aware that the. licensee.does mot have the insurance. coverage required by Chapter 142 of the Massaichusett"s General Laws, 'antil that rhy signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ Sionature of Owner or Owner's Aaent By checking this box Lj; 1 hereby certify that all of the detalls and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations pertormed unser the permit issues Tor tins application will De in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: BY E] Plumber p Gas Fitter Signa of Licensed Plumber/Gas Fitter Idle : - Master Cityfrown ❑Joumeyman License Number: 8678 APPROVED (OFFICE USE ONLY) ❑ LP Installer ZIX 0 W Y C6 = uj Coll O v m= w w CO) N O 2 w LU Z O I- to Q~Q W z m 0 w L a . o O 0 F=> D I. - w LU LU W W w z 9 .til x- CO, � z w > V W Z W 'i H J I- O Z J C9 N LL F- O t. W H W W I Z v >- o o_= to d Q a® g w o O °a z N °� >>> > Z 3 0 SUB BSMT. BASEMENT 1 FLOOR 2Nu FLOOR Vu FLOOR 4 FLOOR 5 .FLOOR 6 FLOOR T FLOOR 8 FLOOR Check One Only Certificate # Installing Company Name: Uptack Plumbing & Heating, Inc. ®Corporation 1415 Address: 32 Rochambault City/Town.Haverhill State: MA ❑ Partnership Business Tel:978 372-8503 Fax: 978 521-1438 0 *6VCompany Name of Licensed Plumber/Gas Fitter: Leonard A. Hall INSURANCE COVERAGE: 1 have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes.® No.B If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S. INSURANCE. WAIVER: I am aware that the. licensee.does mot have the insurance. coverage required by Chapter 142 of the Massaichusett"s General Laws, 'antil that rhy signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ Sionature of Owner or Owner's Aaent By checking this box Lj; 1 hereby certify that all of the detalls and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations pertormed unser the permit issues Tor tins application will De in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: BY E] Plumber p Gas Fitter Signa of Licensed Plumber/Gas Fitter Idle : - Master Cityfrown ❑Joumeyman License Number: 8678 APPROVED (OFFICE USE ONLY) ❑ LP Installer ,Location 4cz`'�1'r f'c�l"ae /A0 No. Date Nom,. TOWN OF NORTH ANDOVER a Certificate of Occupancy $ ,, SACNUS t� Building/Frame Permit Fee $ f j� Foundation Permit Fee $ Other Permit Fee $ TOTAL $/10 Check # `y 17399 `Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT A"11CATIONTOCONMUMMMM OR DWOLISH AONE ORTWO FAMILY DWELLING MEEN,� BUILDING PERMIT NUMER:t - DATE ISSUED: / _ /1`-c U Q v Co SIGNATURE:dyz,/ Buil ' of Buildin Date SECTION 1- SITE INFORMATION 1.1 Property Addrcss: 1.2 A om My end Pared Numbs:, 7;1 5aaaje joe to `off, /� ,Np� ItnCAC� 1/�P� � i 14Iap Nnmba ParoclNumb« �rYI 13 ZadnglafarnEdiae: IA FropertyDbnoadans: zoom Di9ritY froposed use Lot argil 1.6 BUILDING SETBACKS ft Frost Yard Side Yazd Rear Yard Requited Provide ReT&cd Provided RcqWmd Provided t 1.7Wam Sep*hinL.eao. 34) Is. FEooaz000t 2mm 0md'FloodZam 0 A0144 1.8•' S--pDupm9Sy-- o oil WDD40W Syrian a Fabfm 0 1 0 SECTION 2 - PROPERTY OWNERSHIPIAUMOR= AGENT 2.1 Owner of Record hn C A �- l _ �a S«aareaw L. Name (Print) Address for Sera+ ce : L, LOA22LYA, JW = 70 Si Telephone 2.2 Owner of Record: Nam Print Address for Service: siggaturc Tsl e SECTION 3 - CONS7RUCTION SERVICES 3.1 Liocascd Constriction Supervisor. Not Applicable 0 Wniei 31amun lw Lioensed License Number . 8I 15bu►(N/ ANY, lonrndiffl,nA Address ^ o-r/l J06 iL�r_ •X SR ,1sa L. R ti Data -Signature Telephone Z—L-22111 3.2 Registered Horne Improvement Contractor Not Applicable 0 e-1 ��QmundsS�'► gni ��Io� Company Name 1, Number mss stair T `e ou m 2 O G GI v m z m go O .a r m z 0 aa.. a./IN v - "va+aasaw ^-. Kvj Workers Compensat m lnsumm afidatu mast be c ompkted and submitted with this apphcatioa.. Failure to provide this affidavit will res in the denial of the issusm of the building ' Siped afdavitAuachod Yes ...... 0 No ...... D SECTION S Descri on or pos Work On&tilf New Consltttet on' ❑ Existing Building ® Repair(s) 0 Altendio ns(s) ,B' Addition 11 Accessory slag. - ❑ Dettmlition ❑ Other ❑ Specify Brief Description of Proposed Work: X SECTION 6 - ESTIMATED CONSTRUCTION COSTS . Item Estimated Cost (Dollar) to be �` 0iISE b!TL:Y Cor*cted by tapplicant I. Building( MQ, ! a) Building Permit Fee 10, M tier 2 Electrical -(b) Estimated Total Cost of -Construction 3 Plum ' Building Permit fee(.) ..(b) 4 Mechanical _ S Fire Protection 6 Total 1+2+3+4+5 di/O _ Cheat Number sncnurt �e uwrutx nurnuxwwriun ry na wmrs.,arrsr wnrs OWNERS AGENT OR CONTRACTOR APPLIES FOR ]BUILDING PERMIT. L as Owner/Authorized Agent of subject property Herebyauthorize to act on ' My behalf, in all matters relative to work authorized by this building permit appheation.' - Signatum of Owner Date CRf#Mf%ra•n, nwWRIAn UART"nArtiumTIRMARATInN I — .as Owner/Authorized Agent of object p wary Hereby declare that the sla _ts information on the foregoing application are true mid accurate, to the best of my knowledge and beli Print Namc Si tore of ant Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS ] 2NQ 3RD SPAN DIMENSIONS OF•SILLS DIMENSIONS OF POSTS DMMIONS OF GU 1 ERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHlbMY IS BU RDING ON SOLID OR FII LW LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r FORM U - LOT RELEASE FORMA 6n— 1b o INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** J APPLICANT John l ,I,i t c n LOCATION: Assessor's Map Number. SUBDIVISION 1 m A PHONE �-a 37o PARCEL a3 I LOT (S) STREET_ S(Awr%.Ili ( n, ST. NUMBER 7 a *****************************************OFFICIAL USE REC"ENDATIONS,QF TOWN AGENTS: C"'. - - •- , . CONSERVATION COMMENTS DeJ(. u�0111k JL' rRATOR d , :toa DATE APPROVED 9 i DATE REJECTED TOWN PLANNER DATE APPROVED . DATE REJECTED COMMENTS FOOD P TH DATE APPROVED DATE REJECTED DATE APPROVED, DATE REJECTED COMMENTSc�c PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm N q ± ai • 103 97, 'J fA N/F \ .. ,�A3 BRIC KUSIN C� I LOT 31A �� 3, 411E w •�k'e .. - 3 K 4 sor Oww s } I�34 b �a B7 E n • Lw+ 1 �� 3, 411E w •�k'e .. - 3 K 4 sor Oww s } I�34 b �a B7 E n DECKED OUT DESIGN (978) 468-3002 www.deckedoutdesign.com TO Johl-1 Irw4oi v) TEL (H) 14 , 4 (W) DIMENSIONS MATERIALS RAIL JOIST li X DECKING POST FOOTING (7 Io 87 Ida 11> 01 wj FLOOR HEIGHT'- bQ W,-/ STEPS LATTICE SEPTIC SET BACKS SIDING C PERMIT � -k o' 7 Designer Romeo c s r� i C 7 = w b a skoo 444411111; O ar ec m O .:�aooRO� J Q O Q 3 co a m am M r a 1% W L_ OD C O C C-- 20 OO IL m 2 W w M Q-- z Co cry O 12 W Z N mo = O�Fo a1 n m Ce g O iu Z w C O Z o ..� V! m Cil tnO m o c0co m � c 5 Nw pC D co ~ o W N O Z .- v Z m W fro s r� i C 7 = w b a skoo 444411111; O ar ec m O .:�aooRO� J Q O Q 3 co a m am M r a 1% W L_ OD C O C C-- 20 OO IL m 2 W w M Q-- z Co cry O 12 W Z N mo = O�Fo a1 n m Ce g O iu Z w C O Z o ..� V! m The Commonwealth of Massachusetts R v- Department of Industrial Accidents — Office oflnuestigadons - - 600 Washington Street, 74Floor s= , Boston, Mass 02111 Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors .tt CYk. :SwSw`ak Fxs•rs-_„� �r_.j �..2s c �+.r �c - F9 s i".T^" °r"S+ ' r -r "� , � . e�(:C,l - name: tee J1Qi%l�u'nd sS(rn address:2/ AbU ry X41+ e city Rain tV0 r / state: M9 zip: d / 9YJ- phone # 0I 7) 7gni — 7 ?1 r ❑ I am a homeowner performing all work myself. Project Type: ❑ New Construction ❑Remodel *( I am a sole proprietor and have no one working in any capacity. ❑ Building Addition ❑ I am an employer providing workers' compensation .for my employees working on this job. company name address: _ city. -:phone # Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Tine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. to 3-1 DY Print name official use only do not write in this area to be completed by city or town official city or town: permittlicense # ❑Building Department ❑Licensing Board ❑ check if immediate response is required []Selectmen's Office ❑Health Department contact person: phone #; ❑Other (revised Sept 2003) Information and M.-structions r -lens 1',ttLr -152 set -lion 25 reninves all emp-loyers fn provi, e --s" �0111j' --ati, n for T -heir a,-moplu,;cc.:- As `a---"- an ewThjae A Wned as evei7y perscmn tis thc scn'k:c ola--nic-Ithcr iui-idkrauny contract of hire, express Or inNed, oral or wriRen. Pimplover i.s deffined as at -i -mdi-viddual. jparizci-ship. or othcrll"�gall entit"', orartylerr 'o ai..'riore: of ,jilt: f6re-goinig engagcd in a joint eseavrise, and Ii ictuding t -he legal i-q--jesentatives of a deceased empoyer, or thic feceiver or tnu.:stec of an i-ndividuall partnership, asm�ia- io-n or (-)t-' � it'gal tntAy, =Ipluying em loyees. -'-Iowtver tile ovvner offa 'i-�E 1- -- sc, d 7ari us' !1 -'Zit- - �!Li 0. not 1-noye than three. a-i-m—unw-n s and rc--sides ilhcrcin: ta-r ffic, another who employ� persons to do nuainienan-ce, coustructiort or repair work onsud-, dwelling -house lis- o -n the gyawids or builrLuing up!parten- t there -in - all nitot ber-.-ause of's-ocin, ey-np-It-wi✓lent 1- , -�e decnnedi to be an tmploycv UL. chapter 1 -',2 section 25 also states that uveqy -state or joca! 1jeei-is-ing agency shaii withhold the issuance of r_nem! of a Hemet or putrMit to nperate n Honest in bi constrw ni I've for agy appRoant who has put produmd ameptahle evidence of compuance MM flhe 1--n-suriar-tc-a c-n-ri.-erp- c.- nequh-e- . Addiiionaily, nuather conunfLmtweait�, 1-je r ai-ty of its political subdivisions shall enter into any corarad for be ly.nz. 1-�- MAN phnnt: vvvfi -prcsE--u-.0 io Me, camtractnag autnornty. AFetes SBE plemp CnIpprOSAMMI '� - - - 1- f --uppi- an.' numbers Yang with a conjileate of QW-rance as. ail mcay bo subnahred ilk the Depamnentof Also be sure to sign and date the WAVIt. Mv WdavitsbolddhE reumtd U) Ow Lay dhall the appli.-cat-on; RaMpai-Likorhmnse is --reqjivasted;" Fir -it thic D-cpa-nmim�111 011--l"na-usit-in! Widuan, Should pubays any qucKons myrdingfIc MW mif you erre required to obtfinn, a woMrs' corapansation policy, please call tine Deparurient at the riwiibtr listed below. City or lowns b -Fi` -----vi: --=pi ---� md xbod WgRAT The Mps N-wW p-riv -;pi-w--L -a tlhe applic PiEasie Ile SuIre to fill in the pe-TInIfIficens-e aurriber which vnh be useci as a reyerence -trurnber. to thwil. you in advarict !-or you cooperadon and sliould Me Wee oi investigations wouid iiike you have any qucsduns, please do -no! hesitate to givc uN- a Cal I. t-nuut'zi -didue,- ail I IMTR��js- Uffic-e Of 600 Washington Rtwej- FWzy- Boston, via. 02111-E nfivrinc- #� (6 i 7) 77-49MI ext. 40t, 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 F I �ll[�' I puill � o lf1 /Oq Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Q J MR M 0 x M 0 E O Lt f s_`N Q i� v- � xp "O w c� 0 z 9 G w w' U ii a w Z w x a OH w a o4 ii a w x Rr co z 0 v cn ol c o CL 2 ���� m c m CA Alm • ;'la Q Y'd � : a.m.. C D c v sZ .: m <v d 0 r `: 4c C _4r 03r K. g N m 3 r v �omna� Co s y p C 0 — z, wmo i CCDM OLD ® m M 11 �c cm IN C Q p m V H O �,o c CL ce gig n •w CL= W C Z LLIs �E v� N o O CLM FE y 0 ®� o .6 1-- ce m �oy•� o e— 0- O.Am f co O 0 Z O. O CO) � C !� cm i O hW W CD 0 CD .O O O i c C4 CcCc V C 0 C. h m C C _m �. CO) 1. Date 4t .?-. - TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING JSACMU°+E` This certifies that. -- e,-:�.............. . has permission to perform ................... plumbing in the uildings of .. .-... ��::,�- ........ at ...%. ._ -.-4 ...... North Andover, Mass. a Fe�.� ..'"... L,c. No../�'.. ... �. ....... 'P'CUMBI CeIN CTOH Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) `' )W,,ll/� , Mass. Date ZlC 2 Permit #� n / (Installing. Company NameOt3£�T _�i �r�/YIr1'I/}?A�C7 Check one: Certificate Address ?j C Ct: AC H MAfd s -PJ ❑ Corporation /Y) E TW o Fn1 , it l A 01 cis% ] Partnership Business Telephone 7 I 2-,,irm/Co• Name of Ucensed Plumber '&,,3 FiP T Ott SA,�►/IdVI r9 rr4 INSURANCE COVERAGE: I have a current f bility 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 1d 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 ❑ or 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 ormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e andapter of the eral taws. By �(. L re of Licensed Plumber Title Type of License: Master % Journeymab ❑ City/Town - ` , AFi--F lF..D OFFICE USE ONL License Number Y33 5 • z y Of y Z 2 O Vl Y Z < > W W Y J y ! < V < y O O y y U) 2 y W Q y cc ~ '~Q S y to = a O U.1 2 Z 6 :. a 3 �. y = Q y m = y ¢ W �' W F- y y = p < y O Z Q rC a C O X 1i W O f- O f W d y Q D . Q W J y G cc I- -1-C> J D C LL Q 1 -0 > F- O = a y F- = a O C y Z _Z W F- 0 Y y y Q Q O Q J J Q a Q O Q 1- Y O SUB—BSMT. BASEMENT IST FLOOR 2N0 FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Installing. Company NameOt3£�T _�i �r�/YIr1'I/}?A�C7 Check one: Certificate Address ?j C Ct: AC H MAfd s -PJ ❑ Corporation /Y) E TW o Fn1 , it l A 01 cis% ] Partnership Business Telephone 7 I 2-,,irm/Co• Name of Ucensed Plumber '&,,3 FiP T Ott SA,�►/IdVI r9 rr4 INSURANCE COVERAGE: I have a current f bility 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 1d 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 ❑ or 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 ormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e andapter of the eral taws. By �(. L re of Licensed Plumber Title Type of License: Master % Journeymab ❑ City/Town - ` , AFi--F lF..D OFFICE USE ONL License Number Y33 5 z r z N m A �1 O Z .. N c A v m o m z c z m � 2 O D O r C 3 i 69 GJ Date ............/ ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that....................,.........kfti . ........... ... C .................... ........................ has permission to perform ................. wiring in the building of J ........... ?y .......................................... at .... ....... LL.. I-a..1L(,-Nrth Andover, Mass. Fee ........ ........... Lic. No. ........... ............................................................... ELECTRICAL INSPECTOR Check # 89 116 4886 I Commonwealth of Massachusetts offici' s Permit No. Department of Fire Services i Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYP ALL INFORMATION) Date: City or Town of: I� To the Inspector of Wires: By this application the undersigried gives no of his or her int ion to perform the electrical work described below. Location (Street & Number) 7,> Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building Utility Existing Service Amps / Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. 01 (Check Appropriate Bos) .uthorization No. Undgrd ❑ No. of Meters L'ndgrd ❑ No. of Meters (-nrnnletinn of thv fnlln—ino rnhla —) Ao —li—d {... tt, r.. .... .,.. , r rr/;--- 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 Swimmin Pool Above r� In- g grnd. grnd. t 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 InitiatingDevices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices b No. of Waste Disposers Heat Pump Totals: Number Tons JKW No. of Self -Contained Detection, Alerting Devices I No. of Dishwashers Space/Area Heating KW Mun' ' 1 Other on o No. of Dryers Heating Appliances KW Security Systems: or uivalent No. of Water Heaters KW 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 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 cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER [I(Specify:) Estimated Value of Electrical Work: (Expiration Date) (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with EIEC Rule 10; and upon completion. .1 certify, .under pains and penalties of perjOf ury, thathe information on this application is true and completes FIRM NAME LIC. NO.: C oel OP Licensee �Q /1 U l/.Q QUCZ Signatur LIC. NO.� f'V4::7-D%�je (If applicable, enter "eYe pt' - in the licensl number fine.) _ us. Tel. No. Q 3 $" Address: 15PST 5. 2/7- 49 lig//AixT7-h, Ap Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee doe 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: $ i t Location_�- d No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ �r,_/o - i1"� �. Building/Frame Permit Fee $ 11 7` , i-2 Foundation Permit Fee $ /.j Other Permit Fee $ ' Aewer Connection Fee $ 'A Water Connection Fee $`��� TOTAL $ Zf Z ��/, �q Building Inspector Div. Public Works �vILocation Jd�' 9 No. J";�/, Q Date Z-2 -Y- 5�-- f MART" TOWN OF NORTH ANDOVER pt ,,,So 1,.,�0 3? • ° CL p Certificate of Occupancy $� Building/Frame Permit Fee $ " ,sS NO Foundation Permit Fee $1/161 er Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TO AL ' $ / D .o t) Building Inspector Div. Public Works Location 1 No. !� Date t NopT" TOWN OF NORTH ANDOVER Certificate of Occupancy $ • ; Building/Frame Permit Fee $ -'Ss�cHusE` Foundation Permit Fee Other Permit Fe��Q�iQ Sewer ConnectiIMI ee $ i *14b Water Connection Fee $ 5 / 4 r TOTAL$ ti /i lJ D, UC1 n 1 / Div. Public Works 1< I m I u I V Ju I< 1- 1= 1- I> I- I 0I m z F � IL a IL 0 E m a 1 1 1 1 1 1 1 1 1 1 1 I 1 S �1 i Z ^ ^ 0 N N W Z Z m O O N W W F N N N Ift p O 0 m J J i F 4 U 0 N F M W W U W< < J NL CL W 1 1 1 1 1 1 1 1 1 1 1 I 1 S �1 i w — A VNA 0 0 D Z C)ON N mm Ip 0� DZ NZ '°c MM �X-Nj 3nN 010 NO* p3m mx 1LA0 N0 al Z° MOK "a0Z �(o mW0 Wsz orv0 -+0r 'O U)0 D � Z�Z =o vN 0-1 xn Nm ,j cl m D3 r �CA ,* 0 1 D QvD 11 NnN3nOm3NN� OOZ,,cmgm 0D A14 DQ Z"_CDT D N 0 n wu'�c 0 N ;ZW D rmo op mm N ;U. D(A; O 00 N 0 OO 0 ~DO9.n 0. No ,00 =ro ro" Q O ^wy' m T Tj3 N m ZZ O ZO 3 > Cc iZD On N�ZDTN Z � � O30^ODN DDZDN p Z Z61 GI Z� ZOr O { { a O T O N = m D v w m Z ro Z m< O Q > 3 T y N O { { N ~ O D Z N 0 I_ C I 111 COT=m ZND W OmrDZ -N D O pH m m ;r r O lo D =;<>O> D D QroZ T T Z y O D n m O 3.O m roO OT. T OD TNQ Ty DTCZ Z py D Z NN Z O OO Q TOwN{ nDO rZ0 - O ro x X F Z ZN_' Q x Z5 � D D A Z N�0m Z DZ p D n -� Cp0 y T C -L A T z JO 'O D w O D V ro Z m Z O m N X Z O Z Q y Z V Z z A N A IIJ II IJ II T �w I� VIII" I � III II N i IIIIIII� IIII w — A VNA 0 0 D Z C)ON N mm Ip 0� DZ NZ '°c MM �X-Nj 3nN 010 NO* p3m mx 1LA0 N0 al Z° MOK "a0Z �(o mW0 Wsz orv0 -+0r 'O U)0 D � Z�Z =o vN 0-1 xn Nm ,j cl m D3 r _ a CO z15 co Q,rt=—KL'U^ 00 Iz Z Z. o w � m �C7�U awp z QZ oJ V ocl? 0 Z Z > f w�CL zco I C) co a LL z z N u. Y FOLD ALON INE A w X ¢. L N x z Z Z x N LL UJI Op F W H !it i!-! t�.! .� Lj �, i < LL- L- Z _ - w 0 w w z N �x tz J w' z m H v J 0 LL W w_! ! �. r o .L N o 3 Nil; :..! zz (Z t7 ix ji Pz: .LLI ii! Lu 0 !3 M _i o w o ai-} :Y. z cr IL - Lu LL W O LL O r [G I11 EO�D ALONG LINE _ ice! m LLO Z Z Z w O y _ 11• � ¢ S N I t _ \ 0000= 0 x0 y ;i LL 2 O rv� ED tQ . y m 3LL= C z a N U) Z !^ a o = 02 Qo V O 0 Q Ucr d cla ' t jl x W a O A 0 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***************** r APPLICANT: Phone LOCATION: Assessor's Map Number Parcel Rn Subdivision��D -64#e17 Lot s):2,`A Street �(JO ie Cg G �/t St. Number �L ************************Official Use Only************************ RECON[tIENDATIONS OF TOWN AGENTS: Conservation A inistrator Comments Town P Comments Health Agent Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works -- ewe—i/water connection driveway permit r^,+ Zs, Inofo e+ cJ Fire Department flReceiv d= by Building Inspector Date 4 Inspector Date M 1 E U a A o W F- N � vii N J t CC H = O U. IA W > O W > = O LL. 0 Q c O W O: `oQ z =O_ Z z m W F" O N ce C 3 0 � m Q. O J_ >. O z N 0 ad 1 6 z E d CL E A N a� m C) N U- W a A o O E N O >. z '^ U O I— a LAz W p ro 3 CA CA O a i t O +r .a y N o a ro tv ri W 'C m z j 'O ON Z W c C O ro 'ro O N � y a.+ 3 c a`o O CL C ++ c ro U O .o V J L U L Q in oC cL 0 ad 1 6 z E d CL E A N a� m C) N U- -v (A.: lil►II.I)IN(7 C:ONtiI :1(VATION I lla\1:1'11 I'I.ANNIN(; °.3� "-�•' NORTH ANDOVL'1t �'�'J� I �I�'1:;1� ►N t 11' I'1.l1NNING. & (A)IlIAWNY1,1' KAH-1:N I I.P. NI: I . o IN. 1)11 (1 :(: I Ol t CIIIAINL'Y APPLICAH014 ANO I'L'I;MIi I:?��t�lciiii'�Iii •i •1 r.� �� 11 ► :�;� �� i� �� �..., \ if; 1 71 l wi 1 -1 i!; ATE /W6,9- 3o PERMi'r. # zZ )CATION �T �a->9 J�6�✓��� '7� LINER'S NAME: 7/�j��G,,1� 1ILDER'S NAME: lvwfr ISON' S NAME: kSON'S ADDRESS: S� .SON'S TELEPHONE: 0-3 j JERIAL OF CHIMNEY: IFERIO,R CHIMNEY: Fly IMBER AND SIZE OF FLUES: 0M EXI LRIOIZ CIIIMIJEY:;O i/ P��i� Jed ) 1.1- %'xi, f I CKNESS OF HEARTH: Al ---- --_ _ :ZC cfvDiney o4 () vAenCace cull -gutatiow beeii nece,sve(i:--A ,TE: Ile �ne.rtu.i�re►n(�1�•f:A u() •i.ite eulle and Ilctv[' ,iuCe.9 nlrcf .GNATURE OF MASON: :KNIT GRANTED: FEECIO, 'BERT NICE -TTA i L5 JLDING INSPECTOR CC/ ;SPECTEO: _ -'MARKS: SOLID BLOCK 11EQUIRED THIS PERMIT" I,IIISF GE OISPLAYCU 014 111E PUMISES CN W ct t� W w O A a v u O e � a O � z c7 z A a o 7 w° a2' U co w O U W C7 a ca w O w a W w2' cin ca w a0 F � cz w W d w A CQ y w cn O cn uml 0 z J Ln CD z o LZ z o0 ft4 A% c N 0 :4 Z me �> it.�.. i ti O ca N E c c� C-00 C y 3 _ rn c o o � = C C N % O E " R mo � c � N m s S v ff ha •: 4o_ c z m L �a o o 2cm- o 4%� HCD o. c •� co M L m .. c N CL= ca C Z LLI CO cm C.3 co o c c g CO) _ � aoy•� O z $ o.4- � 4 O <� Inv W W ti0 v � O� O Cly 4� Lel O U P Z IOU W W ti O W 0 ER Z H a CA co MaE CDco C O CD C3 m CL CO2 O O V CO) C O L.2 cc a O a COD O V Co CL COD C O CM C CD O .0 D W W �M�y.� CLI) i co O O' Q cmcc CC O J -a O CO Z co Q CIO i' V Z Q CL LMV V O c W z LL W a� V 0 LL F— LLI V 0 cq