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Miscellaneous - 733 TURNPIKE STREET 4/30/2018 (11)
J L -b Town Of North Andover Building Department 146 Main St. Town Hall Annex 508-688-9545 APPLICANT: MICHAEL DEGLORIA Project: r ' MICHAEL'S HAIR DESIGN 733 TURNPIKE ST DATE: SEPTEMBER 28,1997 RE: SIGN PERMIT Title of Plans and Documents: PERMIT APPLICATION & PHOTO OF SIGN Please be advised that after review of your Building Permit Application and Plans that your Application is DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations X Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation of Building Coverage Insufficient Open Space Use requires permits prior to Building Permit Sign requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By -Law X Other SIGN ERECTED ON PROPERTY OF OTHERS. NEW PERMIT Remedy for the above is checked below. Dimensional Variance Special Permit for Watershed Review Special Permit for Site Plan Review X Special Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Other Other REMOVE SING - GET PERMIT FOR PROPER SIZE Plan Review The plans and documentation submitted have the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information requires more clarification. 4. Information is incorrect. 5. All of the above. Health Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure Construction Plans 116 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details Framing Plan Fire Sprinkler and Alarm Plan Roofing Footing Plan Plans to scale Utilities Site Plan Water Supply Sewage Disposal Waste Disposal Other ADA and or ABBA requirements Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information requires more clarification. 4. Information is incorrect. 5. All of the above. The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. CHECK SITE-' .� _9/22/97 9/28/97 Building Department Official Signature Application Received Application Denied _9/29/97_ Denial Sent Referral recommended: If Faxed : Fire Health Water Fee State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. CHECK SITE-' .� _9/22/97 9/28/97 Building Department Official Signature Application Received Application Denied _9/29/97_ Denial Sent Referral recommended: If Faxed : Fire Health Police X Zoning Board Conservation Department of Public Works Planning Historical Commission X Other ZONING INFORCEMENT OFFICER cc: William Scott E PY O-,SLt� 16 N 4t• , , - M t6 OCL _ Town of North Andover .� D.B.A. — Zoning Compliance Form AT•° 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday. J IJ5�' J ),IS 164 1 A7' Addres's of Business: 7-33 Z_niDike_ Q_J 2A Zoning District: Map Lot Phone: 6 n) 'zo--s�3-�L Email J e Q 15OAJ vU Nature of Business: 9G /a Se: %d/ Do you own this property? Yes No Ix If no, written permission is required from your landlord. Will you have clients coming to this property? Yes isC No _ Will you have any employees? Yes No _ Will you have any major deliveries? Yes ?tl No_ Description of Business Activity (Must be Completed) Signature of Applicant For Signage Refer to North Andover Zoning Bylaw Section 6 The proposed use is an cAv�eel e district. Issued_: ' -mate O Z- - Lz Location X33 To rlP' 1!1 So* No. NORTo, Date �` /S-- d TOWN OF NORTH ANDOVER Certificate of Occupancy $ Sa Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ s Check #,=-2 S ! 3 17637 A�M `Ce -.- Building Inspector f Town of North Andover o� No RTh qti Building Department �,? ��`., tit ^b'6 0 27 Charles Street O R ^ North Andover, Massachusetts 01845 * ,� (978) 688-9545 Fax (978) 688-9542 A_ 'QA COCNILII! WKM `y1` 7e �RArEn APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS q3 3 3 7-U rn= e, k LOT NUMBER -SUBDIVISION DATE REQUEST FILED 07 1 f `� _/ q y r DATE READY FOR INSPECTION T Q '( TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY R C)l TTINCI D.P.W. — WATER METER E D`S 6 DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIGNATURE / DPW AUTHORIZATION , Q V � Z LL 0 � Q CL W a O V � o@ r o� Y �' Y • �M4 �Mpi rf♦ W 09 D® Z O � ® , Q V � LL Z W a V � baa ».y r Y �' Y • �M4 �Mpi rf♦ F+y , 1116 Luivilyluly ryrf "1I UP 1VVL3AVi1.11C/M113 urnce use only DEPARTMENTOFPUBIICSAFM Permit No. BOARDOFFMPREVFMONREGUTAHONSSffCM120 Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 �. LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ..-7 3 3 7 ,ern FIkp sY mo P -J Owner o enant) M I G k 4 el S i -fa 1 N 10 e C.4 h To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes [allo (Check Appropriate Box) Purpose of Building Ta ph i n � ¢— Ikt ( Y- S'ci /o n Utility Authorization No. Existing Service Amps_Volts Overhead M Underground rl No. of Meters New Service Amps olts Overhead EZ3 Underground No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work7 -7- Kt d 7 U 11, .P ti U i r 2/0L W& No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and ` N). of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices Vo. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• -Ikl .S k -C/ G t 6-0 20 V o b4- r-.2 - To nil va Ao- � f AJ -1 UV IL l�'�vlS oY 2-7unkto 6--d-r Tejoca(e- t)g I,p hr==CovWr- POWttolhet8gtmarialsdMiqmclusM,sCknaalLaws IhaveaataaYI.di yha m Pbliqyinclucirg CmVl& Covwr-aits&ftc legtrivalai YES C3 NO IhaNesidxrmwdvalidptoofofsffnetodrOffi= YES IfycuhavedrdadYES,pleasein&*theeAvcfcoverageby INSLRANCE BOND oTl�x (ma y) 12- zr�o Q` 0 EVkAmD* Est rn*dva1rofnectical Wcrk $ wolkloStatt hq)ecfi nD,*RequesW Rough Final SigleduttciErtTieP"Ekies 'n FIRMNAME Le &S � � F'L I C) Lh, ucerme J 0 S -Pe h Cr L e U4-(- Signattae DoerEeNo Arkheee ! / r 0 P( e o $'CJ Vl %� � r t �Bu�ssTelNa �`C� (� Alt Tel NoL 9 7 7 .0 r-:at'SINSURANCEWANFR;IamawarethattheLi=wdoesnothavetheinsuimxcu%wWsitssubstantialegivdnasragtlaedbyMassac u9mcl=2wLaws atmysgnahaecnthispwnitfffic ionwaivesMra#unm1 (Please check one) Owner Agent Telephone No. PERMIT FEE $ signature or Owner or Agent �Ap,G REto - ©Cv p� �©2 � Ee Location gU Date No. NORTH TOWN OF NORTH ANDOVER F x p ' _ Certificate Occupancy $ w of �'�s'•••° • tt�' s�cMus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 81,38 Building Ins vG or A ' L CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 90 (8/25/2005) Date: Januga 12, 2006 4 THIS CERTIFIES THAT THE BUILDING LOCATED ON 733 Turnpike Street — Michael's Hair Salon MAY BE OCCUPIED AS Hair Salon — Tanning Booth IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: "iv-chael Hair Salon X33 nrnpike St An ooy 0 5 �uuv�J Build' g Inspector s m m m m x CO) F) m _v y, C .0 CD CD � d � O O 'v 0■ Cf � � O CL y n� o d 0 0 v CDCL o crc �d CD CD CD 0 w w a. �• CD CD a v v, —• o co C v CA O 'D CD Z O CD O CD C WE� Ort =r -4s -.g,aQ y a O K m y o 02=0 m n Z S= VJ -1 �. �aMn C T m �O • p y H � O O m a a O C y�� oo a co o m C C =r ti RI CL.+-•' CID mi, '�J =CD n -C � ` C/) p•d O a As n / C y O a Z N �O �ycog) O ycr=C., cn b' y C)" itty 0 bd c y . �. cn C .900 o N o =1 Ch C o' o.. n y 0 0 c HAI R DESQIIG�t'A 70'3' 1PURNME ST. N01TI-H ANDOVER, MA 01845) (0,73) 685-6175 w Dov) 'S ............... • Dignis Electric, Inc. 18 Samos Lane Andover, MA 01810 978-749-9648 - Phone 978-749-9534 - Fax BILL TO MICHAELS HAIR DESIGN 733 TURNPIKE STREET RT 114 SUITE #2 NORTH ANDOVER MASS 01845 ATT MICHAEL Invoice DATE INVOICE NO. 03/13P03 983 SHIP TO MICHAELS HAIR DESIGN 733 TURNPIKE STREET RT 114 SUITE #2 NORTH ANDOVER MASS 01845 ATT MICHAEL P.O. NO. TERMS REP SHIP DA... SHIP VIA FOB PROJECT MICHAEL 30 DAYS PAP 03/13/'03 ITEM DESCRIPTION QTY RATE AMOUNT TRACED OUT THE DAMAGED WIRE FROM THE CONTROL TIMER ALSO REWIRED THE PHASING OF THE CORD TO THE NEW RCEPTACLE AND TESTED BOOTH #8 LABOR AT 50 PER HOUR X 3 HOURS 150.00 150,00 Mass. Sales Tax 5.00% 0.00 Ri+CEIVE FEB 0 4 20 )5 OVv + ; ,i HEALTH DEPART OVER ENT It's been a pleasure working with you! Total $150.00 Dignis'Electric, Inc. 18 Samos Lane Andover, MA 01810 978-749-9648 - Phone 978-749-9534 - Fax BILL TO MICHAELS HAIR DESIGN 733 TURNPIKE STREET RT 114 SUITE #2 NORTH ANDOVER MASS 01845 ATT MICHAEL Invoice DATE . ` INVOICE NO. 03/03P03 979 SHIP TO MICHAEL'S HAIR DESIGN 733 TURNPIKE STREET RT 114 SUITE #2 ,- NORTH ANDOVER MASS 01845 ATT MICHAEL P.O. NO. TERMS REP SHIP DA... SHIP VIA FOB PROJECT MICHAEL 30 DAYS PAP 03/03P03 ITEM DESCRIPTION QTY RATE AMOUNT FURNISH AND INSTALL (2) 50 AMP 220 VOLT DEDICATED CIRCUTS AND CONTROL WIRING FOR THE HEX TANNING BOOTHS RELOCATED (2) 30 AMP CIRCUITS AND ADDED RECEPTACLES FOR TANNING BED ADDED (2) 30 AMP REEPTACLES OFF THE EXISTING WIRING FOR THE LAST (2) BEDS FURNISH AND INSTALL (4) CONTOL CKTS TO THE NEW FRONT DESK FOR THE BEDS FURNISH AND INSTALL (1) 30 AMP 220 VOLT RECEPTACLE OFF EXISTING WIRING FOR AN EXISTING TANNING ,BOOTH REWIRED THE (2 HEX BOOTHS AFTER WIRING WAS CUT DURING TRANSPORT MATERIAL PLUS 15% MARK UP LABOR AT 50 PER HOUR X 56 HOURS . 1,025.00 1,025.00 . Mass. Sales Tax 2,800.00 500% 2,800.00 0.00 RECEIVE FEB 0 4 2005 T WN Ur2NA. ,AN HEALTH DEPARTM OVER NT It's been a pleasure working with you! Total $3,825.00 Date.... 2 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 'l—,q C- -L11 C -I 6140e6 IL This certifies that ....... z ....... i ........... . ...................... has permission to perform ...... ZPST-ke-MM,�,, nn wiring in the building of .... AW......! at ............ 73-3 ......... T North Andover, Mass. Fee ... I c. No. '�O- Check #" I i. -A � -ELi ;ZiN--S-W R.- V*-",* 5617 IRE CUAMUIV WtAUR UP'IVIAJMCIIUJffil l JOffice Use only DEPARTMR(T0FPUB,UCS4MY Permit No. BOARDOFFIRE REVF.N770NREGUT4T70NS5rGW?12.ia0 Occupancy &Fees Checked APPLICATTONFOR PRRAff TO PERFORMELECMCAL WORK ALL WORK TO BE PERFORMED IN AC RDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE`ALL INFO ATION) Date 8/2--10.. Town of North Andover \ To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) -7 3 3 Tf i r h Fl/<O Is this permit in conjunction with a building permit: Yes Lallo (Check Appropriate Box) Purpose of Building Ta P h t n¢- ()^ 5 d n Utility Authorization No. _ Existing Service Amps Volts Overheada Underground No. of Meters New Service Amps / Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 14'e-4- Kc d 0'01t-9 G r 0- No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total 1 Pumps . Tons KW Initiating Devices No. of Sounding'Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP �0U 4-- - �,G U U e h %=WCovWgrl Rlt =tDthefflq lffZofNL%=usNlsC=aWLaws Ihavea=ML+abt70yku==lolicymhxkgComplee Cowrageaflsmbst2ffW gtuvalart YES NO Ihavesubnidodv°alidproofofwwtoftOffl.�YES � IfyouhaNedrdcedYESpleaseindrakthetypeofcowageby INCE ' (/ BOND MIER ftweSpeci y) Wodclostatt IrMectionDateReWested Signed under tTr arl allies FIRMNAME y • 6- L.e v e- S AA c( t C Liar>sae Jy s -p e^ L e u r sigaute EsbrrmWVakrdEJ"ical Wc& $ Rao I Final ..Lk .UwlseNo. -C/ � "7 y _ Lio=No Risim Tel. Nb. l o Pleo Sa n7� c� ' /` U�l +'t�CJ c e AJLTUTso _9 2 6'7.97.F ? OWNER'SINSURANCEWAIVER;IamawarethattheLioarsedoesnothavetheirrstua MoovvageCritsab t r>balq ivalatasregtraedbyMass dusdNGeneralLaws and that my sgnah ue cn this peuriit appbcaabm waives this tegtma ,fft (Please check one) Owner M Agent Telephone No. PERMIT FEE $ Signature ot Uwner or Agent of No erk TOWN OF NORTH ANDOVER q1't0'6' OFFICE OF p BUILDING DEPARTMENT 400 Osgood Street s'•o�;;.o �:�."�5* North Andover, Massachusetts 01845 Michael McGuire Building Inspector October 3, 2005 Philip A. Parry, P.C. Attorneys at Law 4 Merrimac Square Merrimac, Ma 01860 Re: Michael's Hair Salon — 733 Turnpike Street Dear Attorney Parry: Telephone (978) 688-9545 Fax (978)688-9542 Please be advised that Michael's Hair Salon, located at 733 Turnpike Street is in violation of the State Building Code for construction without the benefit of a building permit. Required approve have been obtained, but the Building Permit has yet to be issued and the required sign offs obtained by the Building Department. If I may be of further assistance please call me at 978-688-9545 between 8:30—10:00AM and 1:00 — 2:00 PM, Monday through Friday. Very truly you, Michael McGuire, Building Inspector I3O,ARDOF.AYYF:_ALSOU-9541 (:u\SYRV-.ATi(riGR&9530 IIFIA III 'M-9540 11,ANNINGo%�-);35 Of Counsel Michael S. Lalikos October 2nd, 2005 PHILIP A. PARRY, P. C. ATTORNEYS AT LAW Philip A. Parry Admitted in MA & NH Thomas C. Tretter Admitted in MA & NH Town of North Andover Office of Community Development and Services Board of Health Building Department 400 Osgood Street North Andover, MAO 1845 4 Merrimac Square Merrimac, MA 01860 Telephone (978) 346-0005 Fax (978) 346-0066 Email phil@philparrylaw.com Website philparrylaw.com RE: Properties located at 65 Flagship Drive and 733 Turnpike Street, North Andover : Owners — PNM Realty LLC and ADN Realty Trust, Manoj Munjal, Trustee To whom it may concern: Please accept this letter as a request for copies of any certificates of occupancy issued relative to the above referenced properties during the current ownership period. Could you also provide me with copies of any building code violations known to be currently outstanding relative to these properties as well? If in fact no certificates or known violations are present, could you please provide me with a note to this effect? I must provide this information to the Owner's Lender as soon as possible. Thank you for your consideration. Please call me if you should have any questions. Yours very truly, Philip A. P rry N PHILIP A. PARRY, P. C. ATTORNEYS AT LAW Philip A. Parry Of Counsel Admitted in MA & NH Michael S. Lalikos Thomas C. Tretter Admitted in MA & NH September 1, 2005 VIA FAX 978-688-9542 Michael McGuire, Building Inspector Town of North Andover 400 Osgood Street North Andover, MA 01845 4 Merrimac Square Merrimac, MA 01860 Telephone (978) 346-0005 Fax (978) 346-0066 Email phil@philparrylaw.com Website philparrylaw.com Re: Jasmine Plaza, 733 Turnpike Street, North Andover, MA and 65 Flagship, North Andover, MA Dear Mr. McGuire: Reference is made to the above -captioned properties, which are both under agreement for purchase by our client. His lender,Bear Stearns, is requiring that we obtain a letter from you to them regarding zoning and building compliance of these said properties. Enclosed for your review and use, if acceptable, is a form letter provided by Bear Stearns regarding the use and zoning, etc. of said properties. Please review this form letter and complete either it, or something comparable, and forward it directly to Bear Stearns Commercial Mortgage, Inc. at their address listed on the form with a copy to our office for our records. The transfer of these properties to our client is expected to happen as early as next week. Therefore, your prompt attention to this request would be greatly appreciated. SLR/ Encl. If you have any questions, please do not hesitate to contact our office. MIN Very truly yours, Sherry L. Robbins SCHEDULE D [LETTERHEAD OF BUILDING/ZONING DEPARTMENT] 200 Bear Stearns Commercial Mortgage, Inc., its successors and/or assigns 383 Madison Avenue New York, New York 10179 Attention: J. Christopher Hoeffel Re: [Property Address] (the "Premises") Ladies and Gentlemen: This is to advise you that the zoning and use of the above -captioned Premises is governed by the laws and regulations of the [DESCRIBE POLITICAL SUBDIVISION], and the Premises have been zoned for [DESCRIBE PERMITTED USE] under [DESCRIBE APPLICABLE ZONING RESOLUTION]. The aforesaid zoning permits the use of the Premises for [retail] [office] [industrial, [public storage] [and warehouse] use and other uses incidental thereto - OR - the use of the Premises is a permitted legal non -conforming use [DESCRIBE RE -BUILDING REQUIREMENTS IN THE EVENT OF CASUALTY OR LIMITATIONS ON OPERATION]. As of the date hereof, the Premises and the improvements thereon are not in violation of the aforesaid building and zoning laws, rules and regulations. [All required Certificates of Occupancy for the Premises have been issued] OR [Certificates of Occupancy have not been issued for the Premises as none are required]. Very truly yours, C LTO 1 _90307077_1 Location ��3 J/c�.� X15. �,`t f No. Date TOWN OF NORTH ANDOVER .o � p Certificate of Occupancy $ ''TS �cMusE`� Building/Frame Permit Fee $ Foundation Permit Fee $ 'Other Permit Fee $ TOTAL $ �y0 Check # i €3 t 5 G 7'- // -Building inspec&I ' TOWN OF NORTH ANDOVER WELDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING _ Section for Official Use BUILDING PERMIT NUMBER: C/10 DATE ISSUED: a� D SIGNATURE: 16z-� Buildin Commissi ner r of Buildings Date 1.1 ; Property Address: 1.2 Assessors Map and Parcel Number. -7 3 3 % qey �9 l f , n i � Z Map Number Parcel Number ' (fit J o� 1.3 Zoning Information: 1.4 Property Dimensions: Zonin DistrictProposed Use Lot Area Fronts ft 1.6 WELDING SETBACKS (ft) Front Yazd Side Yard Rear Yard ReWired Provide Required Provided Repired Provided 1.7 Water Supply UG.L.C.40. § 34) 1.5. Flood Zone Information: Public 0 private ❑ Zone Outside Flood Zone 0 1.8 Sew—v Disposal System: Municipal On Sde Disposal System 0 c 2.1 Owner of Record x -L) Al, hu S 7 3 3 % (- r n P /tee Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent r� 7-7 33 -1 N vi P, /Q S� ,�, . /4 V 4 Names Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ k G- Le rJ cS' AddressLicense Number P- h 54 - Licensed Construction Su sor. 0 oI��te n ' n Exptratt�+ G Si re Telephone (f)T / —/0 7 3.2 Registered Home Improvement Contractor Not Applicable ❑ %, G Le -/ �S Company Name p Registration Number 103 7-72 Address �' 27 3 Expiration Date el C� j —7 Si Telephone T T ic Z 0 0 M X z 0 M 90 0 3 F v r r z 0 I, 1 l C✓ (u e 1 0 G' �U 2 h c. y as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury '-C ku-F 9J 'G ir4 Print Name (� zcs a o Si �of er/Agent Ddte ED Item Estimated Cost (Dollars) to be Completed by permit applicant �� 1. Building )Y (a) Building Permit Fee Multiplier 2 Electrical G O (b) Estimated Total Cost of o 0 Construction from (6) 3 Plumbing Q G Building Permit fee (a) x (b) a oZ Dc 4 Mechanical (HVAC) jrl t4 Lu0 Pt1AT 1� Z 2-0 5 Fire Protection 1 0 o 6 Total (1+2+3+4+5) 00 Check Number sH i'` f >f Efi,+ySLt ,,/y vi{ \up£E y, 4 F�42 >.z�ie >,t J} n 2�. �"">�t�',{�tih t,2� `g.., C. y Cx.r'�-y F4}{.: '>'1:$e{`: ' rd- j"'... p^'%K"i„'�'Y. A. # wk ii t "4 ';k •: }..ii�-skn1 p(�4, ut �4t a,a R.,�a ;'j7.y. ..Fhit `.[y .. S v f+ �•r•Aar.'E.'° < A ,.i F�`��Va�^�;` j C F._..i,: 3Y'O �',?4�.Y'.yy/>F ,"tk ;;f N. ;,1r ,.��1.3�y�i't,��yy lzj� J�,,,Yy4j�t} "Fai,��i"�aY::r `� t. �?''?,..;.y,x�, .,r /.�f.. $. :1f5'�+....,1•.�3� Y �'�'¢s, t7+.�-�. ;E���D� >fi't�,.a�k4 t�A. ���� ��'e.°..-� 2`1 �, �Y H, �..� L r� ?i'C�.. '''f 1.}e. 4E:. .� .;,. i, N_!`�F,S�,:, by ,, ,. ,y;dF,rv-.Tak'�y✓,�n,,. Y# zr NO. OF STORIES S BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 No 3m SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE fc' Sd�+..,i-� - ] WAW ., W+'tr? ETA' `iry� q:Sfr� ax�•q Yyy ; Vc_ ,. .. As, Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea .......❑ No....... ❑ ` �ECTI4N S P1t4 � V ii "411�l�S (`QNS'11'R�iCQN C#il�L i'i!� i w.N ..,..,..1. -..., 5.1 Registered Architect: Name: Address Signature Telephone RMMPTTEITM. 'T MEArea of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone r Area of Responsibility Name Registration Number Expiration Date Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone � 5 Y(�° L-0— (y --C--S leo 2' as a NLv S til Not Applicable ❑ Comp Name: Responsible in Charge of Construction New Construction ❑ Existing Building ❑ Repair(s) ❑ USE GROUP Check as applicable) Alterations(s) Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify 1 Brief Description of Proposed Work: R e v --q. 'J "'J -9 z .Q. -x L 1 VL -,n cJ e l s, e 1 C cd s V C) C- ��� _ % U ❑ 2 so ia), o u j (j �S r To Y, vi 2A 2B 2C ❑ ❑ ❑ C Educational 0 F Factory ❑ F-1 0 F-2 ❑ BUILDING AREA EXISTING if applicable) PROPOSED USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 0 A-2 A-5 ❑ A-3 ❑ ❑ 1A IB 0 ❑ B Business ❑ 2A 2B 2C ❑ ❑ ❑ C Educational 0 F Factory ❑ F-1 0 F-2 ❑ H High Hazard ❑ 3A 3B ❑ 0 IInstitutional ❑ 1-1 ❑ 1-2 D 1-3 ❑ M Mercantile ❑ *" 4 ❑ R residential ❑ R-1 ❑ R-2 0 R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 0 S-2 ❑ U Utility M Mixed Use S Special Use ❑ ❑ ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Ba-;L,ment levels Floor Area per Floor s Total Area s Total Height ft Structural Enaineerina Structural Peer Review Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, l ( L i( t Q I J.� e - (S to r` I A ,as Owner of the subject property ht0-(2u—V S l'u cr 0.95154 Hereby authorize My behalf, in all Of autS Cd V"Jga n X Yr— by this building permit application S' Da act on 978- /4Y;Pb! 1 r . uc -d6 12:02P lu-17rvr�7rroct r.o •20e5 11: t3b F Ma'I� "— a7979a63a4 tNE. ltF'b rlurtG OF twits-R1t A:l t7IMCR OIRaMOOLii AMOWr OR MUM= AMr Wb�� AjaIIT�COdAR1tdC�iD�►�R1l tsA'lE tS a Bvur�lNv M Q st E' i �M�1� i.� A•� sfatt�e+ a --s-=-- ta I -Lf G �TjACta�9 Y Im Y p Y Prai�c Ytv:aed 13 a.1M. or BMW N• �� a ��.Tru s� 7 � 3 Tt,t r , �•e • YI r4C 'ot ft LLO t;U Ll to A 3.i. OF Low t r J l� ea S� $f rai j 7 . �d t = � liS a -i `rn i s uc�rs e eis h j f.tfo"tA . JVD ryuLw 2' CA Lb6LSLb8L6T:Ol :Wau Lb:OT sow-ST-onu 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 or requirements. ************************"APPLICANT FILLS OUT THIS SECTION******""`**** APPLICANT LOCATION: Assessor's Map Number SUBDIVISION STREET OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPf CTOR-H TH DATE APPROVED e ^ _ DATE REJECTED tNSPECTO"EAWrH DATE APPROVED de&14 DATE REJECTED PHONE PARCEL LOT (S) ST. NUMBER a3 PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT (/ RECEIVED BY BUILDING Revised 9197 Jm 4' ' fV S r('N S 130" c� of ing c11, tins. 111 s::n tan ad r�7s HOME IMPROVEMENT CONTRACTOR Registration: 103772 Expiration: 7/9/2006 11 ---Type Individual JOSEPH G. LEMS Joseph Levis��r;:;t=` r,. 65 Salem St Lawrence, MA 01842 '"' Administrator h License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rin 1301 Boston, Ma. 02108 , -- valid out signat► re I�' � %�••ck ✓� `-'��N�C�MiCGKIG t.GGNGLCOG�[Q. � • BOARD OF BUILDING REGULATIONS a ^' License: ?CONSTRUCTION SUPERVISOR � Number.;CS 030651 $ +r.'h Birthdate! 01/07/19 Expires: 011/074606 Tr. no: 15597 Restricted:00 JOSEPH G LEVIS PO BOX 952 LAWRENCE, MA 01842 w Acting of missner i 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 c 11, S 150 A. The debris will be disposed of in: Su/ -gm .X' if (Location of Facility) Signature f Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the office of the Building Inspector Landmark. Insurance 9789753987 02/17:05 02:27pm P. 002 �CORD CERTIFICATE OF LIABILITY INSURANCE opla DATE(MMlpOlYYYY) LEMS -1 10 /2A /A4 PRODUCER Landmaxk Insurance Agency, Inc 198 Massachusetts Avenue North Andover MA 01845-4190 Phone:978-688-8829 Fax:978-975-3987 INSURED - Levis Companies Inc. Joseph Levis 65 Salem street Lawrence MA 01843 COVERAGES IFAS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOn ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INVRtRA: MO.ryland/2uxlch IN';! 1RLR D: Essex Insurance Company IWIMLKG. Safcty Insurance Co. IN`.LIRCR 0: Guard Insurance Group INSURrR F: $ 1000000 i MAIC # 39020 _ 33618 I nt F'VLIGItS (Jr INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 1 HF INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESC,RICICD HEREIN IS SUNFCT TO ALL THE 'TERMS, FXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 00'L • _. LTR IrNSRC� TYPE OF INaVRANCE I POLICY NUMBER ' POLICY EFFECTIVE 'PDATE EXPIRATION OAYF IMMIDDNYI DATE (MM/DD/Y1'1 LIMITS GENERAL LIABILITY B X 1 CUMMERCIALGF,NERALLASILIIY 3CM149S CLAIM: MADE_ X (ICCUR . C!FnfL. AOC-REGATC LIMIT APPLIES P;:. :.. POLICY PRO -..... ,IFt,T LOC AU)OMOBILE LIABILITY C ANY AUTO 821254 ALL vWN;T) AI IT();; X -C.HFUVLEO AUT?S X HiR"L) AUTOS X ! NOWOVVNEr, AUTQ: GARAGE LIABILITY ANY AUTO EXCCSSIUMBRFLLA LIABILITY OCCUR CLAINIS MAOC DEDUL:TIF11 I RFTFNT10N S1 ^ •,. D IWORKERS COMPENSATION AND EMPLOYERS• LIABILITY LEWC509927 ANY PROPRIETOKlPARTNCRIEXFC,(ITIVF i )FF10EPUb1CMI29:.R FXCLJDED? ' Ifyye:, d-r.ribm, under . 8,QIAL I-ROVISInN.S b,1. Property Section JER44P.54333 10/26/04 05/26/041, 05/26/05 DESCRIPTION OF 0P1jRATTON5! LOCATIONS I VEHICLES! EXCLUSIONS ADDED 9Y ENDORSEMENT f SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION LEVI SJ1 SHOULD ANY OF THE A130VE DESCRIBED POLICIES MG CANCELLED BEFORE TUE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAY% WRITTEN Joe Levis NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO REPRESENTA _ _ . � n O ACORD tACHOCCURRENCF $ x_000000 10/26/05 �PRE�MISC4�(G �acurrnon)— $50000 MEDFXP(AnYnneper:son) $ 5000 PER"ANAL S ADV INJURY $ 1000000 C;EN -RAL AGGRCGATE $ 2000000 — I'HODUCTS CON 1P.101 GC= $ 2000000 05/26/041, 05/26/05 DESCRIPTION OF 0P1jRATTON5! LOCATIONS I VEHICLES! EXCLUSIONS ADDED 9Y ENDORSEMENT f SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION LEVI SJ1 SHOULD ANY OF THE A130VE DESCRIBED POLICIES MG CANCELLED BEFORE TUE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAY% WRITTEN Joe Levis NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO REPRESENTA _ _ . � n O ACORD I COMU NEO SINGLE LIMIT $ 01/01/04 01/01/05 rE'arreen♦i s ONLY INJk,)RY (rear person) s 500000 _ 5001LYINJURY 1500000 (Fel acCidonrl PROr'ERTYUAMAGC (Pet :tw1denl) # 250000 AUTO ONLY - to ACCI0CNT S OTI ICR THAN FA AC%C � S AUT6 ONL Y: _ .............. . AGO 5 EACH OCr'URRENCC s___..__.... AGGRFC;ATE S I g TORYLIMI'IS I CR 02/27/04 02/27/05 CL r.-A<-HACCIDErii 5100000 E.L DISEASE•EAEMI+LOYC $ 100000 _ 'C.L.OISFA;F_- POLICY LIMIT $5500000 05/26/041, 05/26/05 DESCRIPTION OF 0P1jRATTON5! LOCATIONS I VEHICLES! EXCLUSIONS ADDED 9Y ENDORSEMENT f SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION LEVI SJ1 SHOULD ANY OF THE A130VE DESCRIBED POLICIES MG CANCELLED BEFORE TUE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAY% WRITTEN Joe Levis NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO REPRESENTA _ _ . � n O ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Ofte of Invwdgaftns Boston, Mass. 02111 workers' Compensation Insurance AflfdaW NNN Please Print Phone am a homeowner performing all work myself. 0 I am a sole proprietor and have no one wonting in any cepa* EI am an employer pravidng workers' compensation for my employees working on this job. r�.... vumnu nimna• L / h c I Address--. Pn�- �--a ►�cd Y,, _�* ^ Policy 0 L 'Q ``' c Cj q cl 2 -7 namrm Co. Palm s Fdkwe to sear coverage • rsgWrad urdsr Sedtan 2501 or MGL 152 can lead tote krapmMm d aknind psnattlm d.• tiros up to $1,500.00 mWor ane yesW Imp bo v. errt.m wd.m.cbApa mMn In tw h= dA ZMP .WDM DFMER. aodA fkw of.glOD.oMA dq MOskwma I w4witend that a copy d this statamant mey be forwarded to the Offow d Imp efts m d the DIA far coverage veriflcdion. v I do hereby cw * amour the pelma anal Pe WW" dp ahoy Od the kdb mft provided Man Is bus and carred Print name Olticm use only do not writs in this ares to be compkated by dty or town affidal' s cl?(f-Gk-7J 7&-3 Cky or Town PerrnlflLicerairg ❑ Buk ft Dept ❑Check iI immediate resparae Is roquked ❑ ( Board ❑ Se/ectrnen's Me Contact person: Phone t ❑ Health Department 13 Other FAx TRANSMISSION LAW OFFICES OF WILLIAM D. COX, JR. 145 SOUTH MAIN STREET BRADFORD, MASSACHUSEM O 1835 i (978) 373-2360 ! Fax: (978) 372.0888 i i To: Tom Collins, Esq. Dam' August 15, 2005 Pages: 2; including this cover sheet. 1 as #: 978/475-7947 g ;From: WILLIAM D. COX, JR. • s Subject: DeGloria v. Munial -d is a copy of the North Andover Building Department application which has , my client I apologize for the delay on this. Thank you. : Zb:OT 9002 -ST-" T'd Lb6LSLb8L6T�01 THOMAS P. COLLINS ATTORNEY AT LAW 10 MAIN STREET SUITE L9 ANDOVER, MASSACHUSETTS 01810 Tel. No. 1(978) 475-8846 Fax No. 1 (978) 475-7947 August 13, 2005 BY FAX TO: 1- 978-372-0688 William D. Cox, Jr., Esq. 145 South Main Street Bradford, MA. 01835 Re: DeGloria v. Munjol Dear Bill, As I requested in my telephone conversation on Friday, August 12, 2005 could you please fax to me a copy of the building permit application with your client's signature that you had previously sent me in April. I apparently have misplaced my copy. Mr. deGloria needs to present this to the building inspector on Monday, August 15, 2005. Thank you and again my apologies for any inconvenience this causes Best regards. ery t ur , Thomas P. Collins � x o x x W4 A QQu a� a v w U)v chi a1,4 A or - .0 w° d U w p4 a aG w 8 a a4 iw a c� w A lz ra o z cn v c� ui CL i t� o COCl y V MCL a _O M� Hm a CF �• ars c C` Ts :m E ice: c Z ` Eiq it J1.. ♦ ;3i y CGo cc rWW � Eg m d:C.3 L.: co :a wo a 64 Z� 3. a � m �m •.—"Z o M� oEO cp d C = O • 3 N CL O LLJ C .0 1=0 _ .a d t O C O O V dGo O C H r .I N [N cm CIO O •— y Q 'C m �mm �3 as � Q o cc O a oca c O C3 C 4D 0 CL C..3 y O C C c CA is W U) W ce W W 69 W uj U) 3 n =O m r� w I • Z f I psi x' Ful -_- y , 5 r A. :1 +, 0 Ln v Z .I a . n - t r ,r �4 Al Co" D z 3 ICDAD S C7O R1 F z o Z S fA m C N 11 41 OZwm O czi ��zz ym�mf Sm '�� o SCD nZ Z y z y z m n m �� C 1 J Z Z7 r o ai/ m =� TTCO _ J Cp 5i z T w p W w 'S y m Q ..,. ll = C� O rmn tn� nmmo'ms 'c Z� " v rnrnDm O zzmzr n (p O D I c_n?7 •-� 1 CID(Drn c O cyxym _`I� -4-4 :Ku43 Z D iZov m D�0 z _`. mm� Mi,ke S 41-A i r D --Q5. Ij REAR ENTRY TO THE UPS S ORE STORAGE NEW TANNING SYSTEM (ROOM #8) � NEW TANNING SYSTEM (ROOM #7) NEW TANNING (ROOM #6) EXISTING THE UPS STORE NEW TANNING SYSTEM (ROOM #5) \/ EXISTING TANNING SYSTEM (ROOM #4) EXISTING TANNING SYSTEM (ROOM #3) EXISTING TANNING SYSTEM (ROOM #2) EXISTING TANNING SYSTEM ROOM #1) FRONT ENTRY Vr TO THE UPS STORE, F-, -- LLJJ L =Jl TTI�..•. _ lu 0 FRONT 'S HAIR EXIT EXIT 3'-11' IEAT IETECTO O� WAITING AREA CERAMICL TILE. FLR. 9'-6' CLG. r_ HNTM 10'-4' 000 (U N �o n i N N Irl O o n U 000 tU n 000 4'-7 1/2' HANADICAPPED BATHROOOM HANADICAPPED BATHROOOM STORAGE COLOR EXISTING HAIR CUT SECTION O a Ia '/ I LEGEND EXIT SIGN 'Ilii� MAIN ENTRY EXIT L❑CATIONS ' 3'-3 1/2' 4'-2' 4'-2' 3'-3 1/2' �o HEAT DETECTOR 14'-11' • EMERGENCY BATTERY L❑CATIONS EXISTING WALLS EXISTING HAIR DESIGN BRANCH LINE _ _ _ _ _ COMMERCIAL SPACE CONDITION -� SPRINKLER PIPE NEW WALLS Scale 3116"=1'-0" �'ro��' 2'X2' ALUMINUM LLL LJ AIR DISTRIBUTION OUTLETS THESE DRAWINGS SHALL REMAIN THE EXCLUSIVE PROPERTY OF LUIS WALDRON AND ITS CONSULTANTS, ALL RIGHTS AND PRIVILEGES ARE RESERVED BY THE DESIGN TEAM. NOTE: THESE DRAWING SMALL NOT BE DUPLICATE WITHOUT PRIOR WRITTEN PERMISSION OF LUIS WALDRON. DRAWING TITLE L. Waldron 1 r t OWNER. THE CONTRACTOR SHALL BE RESPONSIBLE FOR THE EXISTING HAIR DESIGN COMMERCIAL ARCHIIECTUREIAUTOCAD MICHAEL'S HAIR DESIG SPACE CONDITION AND GRAPHIC DESIGN"' „ 733 TURNPIKE STREET COORDINATION OF ALL FIELD CONDITIONS, DIMENSIONS AND CALE:3116'=1'-0' SHEET. N0. 21 Bow St. • Saugus, MA 01908 NORHT ANDOVER, MA 01845 COMPONENTS OF THE EXISTING TEL: (781) 231-1907 h (978) 685-6175 BASE BUILDING ELEMENTS WITH )ATE: 03/11/2005 RAWIN BY: LUIS WALDRON N0. DATE FAX: (781) 231-j907 F THE WORK AS CONTAINED A2-� -- HEREIN. EVISION: 1-7-61 Date.................................. 0, TOWN OF NORTH ANDOVER ( * 0 0 PERMIT FOR WIRING .1-1. rl. �• This certifies that ...................... ......... ..................................................... has permission to perform .. . ....s .................... �— ....... "L' (5r " I wiring in the building of ................. / ....... .......................................................... at ............. 3 ................ ........ . North Andover, Mass. 04" . . ...... Lic. ............... ................................... ELEcrRicAL INSPECTOR . ............. Check # 794 4 r �•������ivnwCcaiLn �r M8ssacnUsetts Official Use Only Department of Fire Services Permit No. 9� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 1/07] eave bl k APPLICATION FOR PERMIT TO PERFORM ELECTRICALan All work to be performed in accordance with the Massachusetts Electrical Code'(MEC), 527 CMR 12.00 W �Y ORK (PLEASE PRINT WINK OR TYPE ALL INFORMATION Date: City or Town of: NORTH ANDOVER 79-1--c e Inspector of res.- By this application the undersigned gives notice of his or her intention to perform the electrical work dWiescribed below. Location (Street & Number) -1,33 i- r Owner or Tenant 0 'P. Owner's Address�`Un` j� Telephone No. Is this permit in conjunction with a building permit? Purpose of Building 'r Yes NO ® (Check Appropriate Box) Eidsting Service Amps Utility Authorization No. � 2�? / 0Volts Overhead Q Undgrd No. of Meters New Service Amps / Volts Overhead El Undgrd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: mics,, ,��•,�_. .,_ No. of Recessed Luminaires No. of Luminaire Outlets No, of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers o. of water Heaters KW No. Hydromassage Bathtubs L-om letion o the No. of CeiL-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool AboveEl d.grn No. of Oil Burners No. of Gas Burners No. of Air Co d. otal !H eat:um To talsumber Tons - --- Space/Area Heating KW Heating Appliances KW No. of No. of Signs Ballasts ------------ No. of Motors Total HP vin table may be waived b the Inspector o Wires. No. of Total Transformers EVA Generators KVA o, o mergency JJghtmg ALARMS INo. of Zones o. of Alerting Devices non/Alerting Devices Municipal Connectins ❑ other No. of Dei Data Wiring: of Devices Estimated Value of Electrical Work: mach additional detail if desired, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: c9% 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 is u The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. he CHECK ONE: INSURANCE ® BOND ❑ OTHER [] (Specify:) I certify, under the pains andpenalties ofperjury,i54!that the information on this application is true and complete. FIRM NAME: 14602- Z' t4lC Licensee: �14 A16,Vl 2. LIC. NO.: A lq(f< ' (If applicable enter "exempt " 'n the license n bei line.) Signature �, r LIC. NO.: C-322ol Address: s ��,(�� �ltQ Bus. Tel. No.: G,!? *Per M.G.L c. 147, s. 57-61, security work requires Department ofPublic Safety S License: Alt. Tel. No.: SqZ Sb -7q OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have,the liabili Lic. No. required g law. By my signature below, I hereby waive this requirement I amth (check one) ❑owner ty insurance coverage normally Owner/Agent ❑owner's agent Signature_ Telephone No. PERMIT FEE: $ /"`� I- J The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 { I www nz=s.gov/dia . Workers' Compensation Insurance Affidavit. Builders/Contractors/Eleetricians/piumbers Applicant Information Please Print Legibly Name (Business/orgenizationl[ndividual); MC)oz ,! 71rcvei c— . Address:. ,7 CitylState/Zip:tn�i2i,i D 0 �i4 S Phone #: Are you an employer? Check the appropriatebox: 1. F -1I am a Employer with ",!74, C31 am a general contractor and I employees (full and/or part-time).* 2. [] I amA.sole proprietor. or partner- ship and have no employees working for me .in any capacity. [No workers' comp, insurance required.] 3. ❑ I am a homeowner doing all work myself, [No -workers' comp. insurance required.].t have hired the sub -contractors listed on the attached sheet; 1 These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c, 152, § 1(4),' and we have no .empioyees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ .Electrical repairs or additions I I Plumbing repairs or additions 12.❑ Roof repairs 1.3.❑ Other *Any applicant that checks ba # 1 must Also fill out the section below showing their woikers' oompansation policy information,. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside commctom must submit a new affidavit indicating such. ;Contactors that check this box mustattadred an additional sheershowing the name of the sub- contractors and their workers' con P policy infnrmadon ! am an employer that is providing_workers' compensatum insurance for my employees Below is -the information policy and job site . Insurance Company Name: ------------- Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address. 73.E City/State/zip: ' Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date}. Failure to secure coverage as. required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ! do herebyce under thepains nand penalties of perjury that the information provided above 'a true and correct Signature ► \ (� Date: [ 2--r-O % Official use only, Do not write in this area, to he completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building. Department 3. City/Town Clerk 4. Electrical inspector 5. Plumbing inspector 6. Other Contact Person: Phone #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the'foregoing engaged in a;joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee -of an individual, partnership, association or other legal entity, employing employees. 'however the owner -of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on'the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shalt withhold the issuance or renewal of a license or permlt to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence lot compliance with the insurance coverage required." Additionally, MOL chapter 152, §25C(7) states "Neither the commonwealth nor any of its -political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Please fill out -the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es)..and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or. Limited Liability Partnerships (LLP) with ..no employees other than the members or partners, are not mquired.to cant' workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavitnriq be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also bre 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, notthe Department of Industrial Accidents: Should you have any questions regarding the law or if you are required to obtain a workers' eompensation.policy, pleasecail the Department at the number. listed below. Self-insured companies should enter their self=insurance license number on the'appropriate'tme. 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 permitflicense number which will be used as a reference number. In addition, an applicant that must submit multiple pennit/iiomm applications in any given year, need only submit one affidavit indicating,current policy information (if necessary) and under.."Job Site Address" the applicant should writo "all locations in (city or town)..". A copy of -the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a 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 of Massachusetts Department of industrial.Accidents Offiee of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-977-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.nzass.gov/dia e 4 as 0 715O a S O w 0 Ot J TQC rr��c S� o f 1 of 0 - U E� r�•: r ` "Qo h as � Mil a♦** � pro 0 0 Z 0 E-+ as 0 715O a S O O � z o 0 0 b H ' VJ VaJ :i w Lr ..r ry1 000 O k � N -� A b 0 0 U15 o t. ° ° a, a 0 N � a b z •�+ M k O tO �N o Aw '��' o`°o 0 0 > as 0 715O a S 0 r i 0- m iP I'm W" U) Q U cl O d O O cn C cy�d" � O x C'3GQ li N ��s+5 o y to Q cy�d" tUi U O � � o b W �n. V cud, U Q, an wow � W rA . 3 ° C� I., a� �'•~ cd i O cd y 'C O O cd U ,—, cd R �+ O Q, •--� U C14 o Cd Q,En 'da � � o z �. o Cd � z'° Cd V�" 3 -.- N. Q orb w a � � o b W z U � W 00 to cd i O r. O 0 -- R �+ O Q, � O U C14 o Cd Q,En 'da � � o z �. 3 -.- N. Q w a o W z U � W � 3 a 3 � � o z �. o Cd � bD an H O w Q N U o 0 z p v w ao r. 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