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HomeMy WebLinkAboutMiscellaneous - 75 FOREST STREET 4/30/2018 (3)N O I O i J O 7 O 1 O � O O � -_ N 09918 Date .� �.. . Z• TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...�140-lj ...... .. �..... . has permission to perform .. 14. .►.�.........`.J.................. ............. plumbing in the buildings of. �,.!e U ��� at .... - .. i7 r� s it'"? Q -{', , , , , North Andove a s. .. PLUMBING INSPECTOR %heck # 'i - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK LW CITY f 1 L/�� _ I MA DATE PERMIT # 961 JOBSITE ADDRESS D si 5l32° OWNER'S NAME POWNER ADDRESS �Or'G 6 7 _ __ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: Q PLANS SUBMITTED: YES ® NO FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM I _._. I f _._._..___► _._ ___( -.- ___-_ _ _( _-.-_._. __ _ (._._. _( DEDICATED GREASE SYSTEM —1 I ! _.__...._ I J _._1 { ._._..._._� .__.1 J } _f ._-_._.-_i DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER l 4 _ .-�i -.. 1 �! I _-_-.I ; ____-_! DRINKING FOUNTAIN _. _} .___..._ 1 _...___� _.._.__.._( i I ____...__( __-___I .-._-! _-_-__f FOOD DISPOSER Ft00R/AREA DRAIN i __...._._E ..__._-� _.____1 INTERCEPTOR INTERIOR - i I i i _...___) J I 1 i _.__.._I t.ITCHEN SINK —I _._ _._I ! 1 ...__.___� 1 ( _-_--i ----- __.{ LAVATORY ROOF DRAIN SHOWER STALL i ._..___ 1 J I i ..-.___._.J _._.-_J _.-}-___._} .__.___I __....__I -___J } _i SERVICE/MOP SINK TOILET I ( i . _. I 1 I j 1 _I __.._.._} _.._-..._ URINAL ! E � ___---1 __._! WASHING MACHINE CONNECTION _-___-i _ _I WATER HEATER ALL TYPES _ = WATER PIPING OTHER=7 INSURANCE COVERAGE: hVe a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES M -NO Q IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY Ej 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 0 AGENT 10l SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in wit erti t pr, vision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME .- --)IVl _,.I LICENSE # SIGNATURE MPO JP CORPORATION [3# PARTNERSHIPP#F LLC I COMPANY NAME Lf �L 9�2,Gi9 S ; ADDRESSA. CITYL4.:14(_ S '!<_/.__....__ . _.. I STATE ZIP� TEL �/ FAX CELL ! MAIL o z t } i Ul - 0o D I i m i r- n' f mom, 3 i N H Z 3 y Zr-^` • c L4 D :. mE z -n,� O D c W Q a z n n M Dm . m 1 o N� D o 3 = N m D r ; a s CD u, t7 m ;o > C-03 '0 Ozr _ i r c m CG 0 a • r Z r- "ar` M min n I z -n o I o L4 m �— a ° ° DR. R 1 N -n ZT. I Ln to rN C i Cl)co M • o c m Signature 1 o-nZv nra� I oi;�"n cp v -isoo ;oN-4or- Z Dm Z z mT,.IE � om-q n aam> m c-DigZv � -IzQ mZ vo This certifies that . . . -K1AOL^J. . l�.Vv^.Ie.l has permission for gas installation . ............. in the buildings of .. ............................ - at .... 5 North Andover, Mass. Fee.?..'D—Lic.No—Z'".. GASINSPECTOR Check # 0676 CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER n INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY F-31 OTHER TYPE INDEMNITY Ej BOND ED 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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application and that all plumbing work and installations performed under the permit issued for this application will be in Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME CV _....... _C1%M 1 LICENSE # are true and accurate to the best of my knowl com ' r1ce ith rtine ro ion of the SIGNATURE MP MGF9 JP [RJGFE LPGI E] CORPORATION _[#V� PARTNERSHIP[�f#_ _ LLC (# ,_,._-__j COMPANY NAME: _g_-______ J1ADDRESS L:_:� CITY ^ f' S T G —, _ _ --_. _ _.. _ _ ._ _ _...___I STATE ZIP FAX _-- ��� CELL � W _ AIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY, ►' _/�.�MA DATE PERMIT # JOBSITE ADDRESS1_-7 _ 0 e� ,T _ OWNER'S NAME GOWNER ADDRESS a Ac Ic 1 TE TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL E] RESIDENTIAL CLEARLY NEW: [Q RENOVATION: REPLACEMENT: 0 PLANS SUBMITTED: YESF--] N00 APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER n INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY F-31 OTHER TYPE INDEMNITY Ej BOND ED 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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application and that all plumbing work and installations performed under the permit issued for this application will be in Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME CV _....... _C1%M 1 LICENSE # are true and accurate to the best of my knowl com ' r1ce ith rtine ro ion of the SIGNATURE MP MGF9 JP [RJGFE LPGI E] CORPORATION _[#V� PARTNERSHIP[�f#_ _ LLC (# ,_,._-__j COMPANY NAME: _g_-______ J1ADDRESS L:_:� CITY ^ f' S T G —, _ _ --_. _ _.. _ _ ._ _ _...___I STATE ZIP FAX _-- ��� CELL � W _ AIL .4 �A The Commonwealth of Massachusetts Department of IndustrialAccid&its 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 Leizibly Name (Business/Organization/Individual): !/ Address: AGI City/State/Zip: Pl j�`G S I I/ Phone #: L6) y G Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I (full and/or part-time).* have hired the sub -contractors 2. IVinployees Iarn 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. El Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 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. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company N Policy # or Self -ins. Lic. #:. Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: 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 .1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial .Accidents Office of Investigations 600 Washington. Street Boston., MA. 02111 TeX. # 617-727-4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax # 617-727-7749 wwwanass,gov/dia s i I Ul co y I N iD Z o Z 3 y Zr-fnC O O D C703 S� o o Z 0 C) mDm • m o � (nm a rf m r-1 o 3 y o i cd m a`D 0 o0 _ iI D C o D -n E � - c 2 m C) n r m fn n I -o X` o (n m -<-rt N j o W m N w CD 0 n� o N I LO z � CD- W Cl) m, Signature 1- _ i 0-nE-0 -n0�.0 nt=a� .. M .-i 0 M;; n y q� mrn-4T O M =s0� m(Acnn o y cn-I r Z DWZ� -I CA03ZO m -i Z -i t C) pm0 Dpm> m e-DioZv m v N 07D -i to Z m0 O f I s it Ak 3P Date ..,T- ,......-...............- ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... \,..rkA /� ....... �4C ......................... h - permission to perform ..... 1.4.—kw ....... A.� ;ks MEL / wiring in the building of ...................... I ................. 5w .............................. at ........ !S7 ....... 1F"ReFS ....... .......... . North Andover, Mass. Fee ... Lic. No -113-3.14 .................... 0�1 .. . .. ...... ELEcrRi SP*ECTOR Check # 7 4 6 t�ominonweahL of /Y/aajacLusef% Official Use Onlly 17 cc� c�'] Permit No. 72 2epartrnent of ire Servicee Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code M }, .) CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL 1 FO lATION) Date: 3' U City or Town of: A To the 177` ectot f Wit•es: By this application the undersigned gives n tice of his gsdicr intenti"oa'to perk e electrical work described below. Location (Street & Number) � 1-�S Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps 1 Volts Overhead ❑ Undgrd ❑ No. of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: � Q,a P'3-�'i7 Completion ofthefollowing table inay be ivaived by the Inspector of 141ires. %, No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total -l Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- 11o rnd. rnd. EmergencyLighting Battery Units Units No. of Receptacle Outlets No. of Oil Burners IFIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection andInitiating Devices No. of Ranges No. of Air Cond. Total Tons No. Alerting Devices g o. o No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained Total Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kir Security Systems:* _ No. of Devices or Equivalent No. of WaterKWNo. of No. of Data Wiring: Heaters Si ns Ballasts No. of Devices or F, uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additianal detail if desired, at- as required by the Inspector of 141'ires. 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 age is in force, and has exhibited proof of same tot permit issuin //0 e. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)'�C'&AC# � /Z�31 certify, under the ai andpenalties of erjury, that/qte inforrmaatiion on this application is true and clete. _( FIRM NAME: �ti 64 G l_!T �-4—n _ LIC. NO.: - Licensee: 'Slwhe, A Signature LIC. NO.: _ (lfapplicable, enter "exen t" h2 IN license number��e.) t /Bus. Tel. No.:.'; �a •'f i,'� C%?� Address: ��� It L 'ea I, ,t �(� U v � Alt. Tel. No. - *Per M.G.L. c. 147, s. 57-61, security wor requires Department of Public Safety "S" License: Lic. No. _ OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature _ Telephone No. PERMIT FEE: S _ — T5��j &P�- (,P- - a- 0 , &--7 /� The Commonwealth of Massachusetts q Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 5 tckeei zinc City/State/Zip: !J (�YI {�� Phone #: J -)e Are you an employer? Check the appropriate box: ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors >,. ❑ I am a sole proprietor or partner- listed on the attached sheet. + 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 These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions I l .❑ Plumbing repairs or additions 12.❑ Roof repairs l3. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. ^-L n // Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site A Expiration Date: /2-/b//0/ City/State/Zip:A 01 YCd Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, a the pain d p aId of perjury that the information provided above 's tr a and correct. Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Location 176 4 5 No. O! Date 20 _,0 oF TOWN OF NORTH ANDOVER i Certificate of Occupancy $ ,�j Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee � $ TOTAL $ l ,/ Check # 1 C v V 6 Building Inspector Location No. _� Date TOWN OF NORTH ANDOVER ,.-. 0L Certificate of Occupancy $ s�cMusE`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee ?",Of $ TOTAL $ Check # 15066 l� 6 Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING i }gisCChldH : or ICI&]E ` 9e BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Tly In; Building Commissioner/I for Buil&n Date SECTION I- SITE INFORMATION 1.11 Property .Address: 1.3 Zoning Information: 1.2 Assessors Map and Parcel Number- -ID G 0(-70 Map Number Parcel Number 1.4 Property Dimensions: Zoning District Proposed Use Lot Area s Frontage (ft) 1.6 BUTLDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R9qwred Provided Re red Provided 1.7 Water Supply M.G.L.C.4D. 54) l._. Flood Zone Information: - 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name Address for Service A k— Z — SG 6`10 I Signature Telephone I 2.2 Owner of Record: Name Print Signature Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: h I r Licensed Construction. Supervisor: I 7o S'-. Address SI nature Telephone 3.2 Registered Home Improvement Contractor P,. -o Companv Name s Address for Service: Signature Telephone Not Applicable ❑ ®(v 33o License Number Expiration Date Not Applicable ❑ J(9-Zo� Registration Number oz- G- 03 Expiration Date SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... X No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition 0 Other 0 Specify Brief Description /of Proposed Work: 19X SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b mut applicant kUFFXOIAI'fiTSE�ONLY y� 1. Building �. 3 �ad / (a) Building Permit Fee Multiplier S� 2 Electrical (b) Estimated Total Cost of Construction 9 n0�o / '7 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, •�i� P e �.��- c J� as Owner/Authorized Agent of subject property Hereby authorize-• `'1, P—Q-4 4 to act on My behalf, in all matts rel tive t work ithorized by this building permit application S pc 13 .. ? Si gnature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Au or Me7D>nt of subject property Herebv declare that the stateme d information on the foregoing application are true and accurate, to the best of my knowledge an�11 e Pr a e Signature of Owner/Agent AA Date NO. OF STORIES SIZE BASEMENT OR. SLAB SIZE OF FLOOR TINMERS 1Sr 2 ND RD3 SPAN DIMENSIONS OF SILLS D[MENSIONS OF POSTS Dt-MENSIONS OF GIRDERS f EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CI-BMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL, GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ............................................................................ APPLICANT 4e4,AtP( t bo -1 Mtis0ki PHONE 9?k-6kZ- g640 ASSESSORS MAP NUMBER /©(O LOT NUMBER D (% O SUBDIVISION LOT NUMBER STREET STREET NUMBER ? ............................................................................ OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS .... ................................ saw .................. ............■ DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED TOWN PLANNER FQ D INSPECTOR ALTH SE TIC INSPECTOR - HEALTH r'na,rnA-UNrrc PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED 14 0 S'N I \Ita ' DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DA' NAME ADDRESS CITY— J FAMILY Pools & Patio, Inc. Sales - Service • Supplies 70 So. Broadway • Lawrence, Massachusetts 01843 Tel: ( ) 6888-8307 Fax: (j ) 688-1949 CROSS STREET b EST. START DATE — CSL # 010330 HIC # 118204 WC # 156942897 LIAB # C0164095968 DATE / q d . U 20 W_ ZIP .1?L C—TELEPHONEqJ k -- Ck 1 yU Res. EST. COMPLETION DATE • PROPOSAL. - NT13 r t 'A We proposse to furnish and install one i g x s swimming pool for the sum of $ 9uy ;It rice for normal installation consists of: Nine hours total machine time including two trips for excavation, backfilling, and rough grading around pool. Use of one dump truck for six hours for removal of fill during excavation • Installation of pool with filter and wall skimmer. rice does not include: Any machine time over nine hours, additional machine time to be billed at (IZer hour •Any trucking over six hours, additional trucks to be billed at {��) per hour •Any dumping costs incurred for disposal of ledge or large rocks Re -seeding of grass around pool • Spreading of loam • Trucked in Water • Patio or fence around pool or any accessories, except as noted below • Additional fill, if necessary, for proper backfill or reshaping of hole • Disposal of large rocks Fuel Connections • Heater Venting • Fuel Storage Tanks • Permits • Damage done to sprinkler systems or any buried items (ex. dry well, electrical lines, cables, etc.) in the access and pool overdig areas. ping and removal will be subject to an extra charge. r or soil condition (ex. clay, peat, live sand, excessive rock, etc.) requiring Min. Max. ne pack of the hole will be subject to an extra charge of �� 6 � of the above will be at the discretion of the job supervisor. omer; is to supply access for all trucks he owner's responsibility to obtain the building permit or to assume the costs of necessary permits. -EXTRAS- Vacuum EXTRAS - Vacuum Cleaner Ladders) (2/0 Diving Board te ty C�L ) Chemicals Maintenance Kit Lifeline Main Drain Solar Cover ( ) Fiberoptic Light Heater { Slide Caretaker 99 Pkg Environpool plus Pkg$- Environpool Pkg Polaris Vac Sweep Polaris -retrofit only Inline Chlorinator ❑ Patio, Electrical, or fence, see attached • CONTRACT • Steps /} w Filter >(� S k4-( ea t* With t�rHP Pump Liner V �t1 Coping .�_. Spa Miscellaneous Miscellaneous { ) TOTAL EXTRAS 3 sv BASIC POOL PRICE 13 flt� SUBTOTAL $ 5% MA SALES TAX 1 S TOTAL 1 $ LESS DEPOSIT 5% minimum F 73 BALANCE OF CONTRACT4 ����rrAA vt,II.S° ' U 6 YA PAYMENTS: 1/3 Excavation, 1/3 Backfill, 1/3 System Start-up The buyer hereby agrees to pay in full, the total amount of this transaction upon start up of installed pool. You, the Buyer, may c el this transaction at any time prior to midnight of the third business day after the date of this transaction. Credit card payments not acceptedon c ntract amount j BUYER CO -BUYER Jun 26 01 11:08a Family Pools & Patios Inc 8766881949 Z N P. 4 s� 0 2 (a C Ui rn 0 00) N N 0 o ogOCOo w C n fy O Q" m Kp — C2. to m N -U( j a3c 0 U o "" N o S J 4 fipr 20 01 U1: USp I -ami l!d Pools 8, Patios lno 9'7060U1949 �'r>,:• � ✓ ti � Lna+x.r�rnx+oea lJ% o Board of Building Regulations and Standards I,. HOME IMPROVEMENT CONTRACTOR Repitttratlon: 118204 EXPIM l0n: 02!1312003 Type: Supplement Card FAMILY POOLS 6 PATIOS INC GLEN WIOGN TO S. BROADWAY u, ,-,Pt*�•� LAWRENCE, NIA 01843 Administrator " .-.r�.s f5!»xtnartaJeulG4. of'.•��n•raa�e.de�12 Board of Building Regulation' and standards HOME IMPROVEMENT CONTRACTOR Registration: 118204 IF 02/1312003 '. Type: Supilernenl Card FAMILY POOLS &%gP0015 INC OyNTHIA: otA ObtILOS TO S. BROADWAY IAWRENC9; MA01843 Adniniatrator • 1 .moi e io.wmon.Id o1:: l.".1.(ueefta s� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration; 118204 (� p�tpin8en: 021 312003 l l ;Type: prlvale Corporation FAM ILY,ROOLS PATIOS INC IMLL4WI�G�NORdULUS TO wGRIMMAY (AWRENCEA%01643 Adminitirator License or registration valid for Indlvldul use only before the expiration date. if found return to: Board of Building Regulations and Sinndards One Ashburton Place Rm 1301 Boston, .Nla. 02108 Not valid althoul st¢ t •c 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 Rm 1301 Boston, Me. 02108 Not valid without signs ure 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 Rm 1301 Boston, Ma. 02108 Not valid without fignatnre p.2 ACORD,N vmww'4` (ULIJO9V'avvv . Elliot, Whittier, Hardy 11 Roy Insurance Agency, Inc. 51 Pulliam Street Winthroor MA 021SZ Femily Pool a Patjo Lo., 91 South Broadway Lawrence, MA 01643 —E / 1 N9URAE\CE-----,j aw�¢IMn,ioOntir 03/09/2001 RF0RMATItm— 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 IIIEUREkA Transcont nenta ins. Co. INSURER I' INSURER C' n+IupeR IN$URER E IrV VCRAVY� 11 a r".".L`]'N HA'/E BHEN . IID H LIVE FOR THE L C 1 C JI NDI 10 ANY REQUIREMENT. TERM OR CCNDITION OF ANY CONTRACT OF; OTFIER DOCUMENT'MTH RESPECT TO WHICH TWO CERTIFICATE MA" BE ISSUED 017 PTAIN, THESUBJECT TO ALL THE TBRM$, EY,CLUSION6 AND CONDITIONS OF SUCH MAY NAOOREOATG EHOWNCE1 BY Tt4E HAVE BEEN RIES tieseB BED ID CLAIMS. if; OTIC TYPE OP INIURANCR POLICY NUMBER DATI MM/DO, EUMI!B GENINALL"L"Y COLM,IBRCIAL OENIRAL LIAaILITY GIVMO MAN a OCCUR 164095968 12/31/2000 12/31/2001 EA.ChOlv,PutEM3 1 50000 FIRE DAMA3E (My one lin) I 500 _ MED Gl(P (Any one re -won) a 50 PERSONAL A ADV INJURY r 5000 A OENERALA6AREOATE 1 10000 gnO pEN1A0 ToA filM1R.'APPLII6PIR PRODUCTS •COMPIOFAGO ! 10000 POLICY J�CT LOC AVWuoaN.NLIAOIIrrY ANY AVTO 038607 12/31/2000 12 31 2001 COMOWGO$*IOL:UMIT Me favid«fY E I 1000 000 (Nooj RY Pftif A ALL OY,MEO AUTO0 SCHEDULED. AUTOS MIRED AUTOS MON•OWNEb AVT09 I i GODLY INJURY F IP., faae.nn ogorenrr DnMnce f (Per OOC *M) - — - 1 OAMOI LIABILITY AUTO ONLY . EA ACCIOFNT f OTHER THkH EA AGC I AUTO OKY: AGO S ANY M" IXCENa LIABILITY SACH OCCURRENCE 1 AOORSOATI 7 OCCUR Q CLAIMS MAOI _ OEDUMOLE , _ E RITlNTX9W f MfOgRN11aCOMINNIAnONAND 164095968 12/31/2000 12/31/2001 TU LI IR18 I R L.L. EACH 4CCOtNT f EMPLOYEILN' UAa1LIrf A II L. DISEASE • EA EMPLOYEE f E.L. DISEASE -POLICY LIMIT $ OTHER IADDED 87 RHOOKOEMI IMMIX[ FRUVIS INS Vay{1IrIVRICFIV4VGn I IlVDDI11VriRlllMyVryCu:mevnen�al,en 1 For Information Purposes Only SHOULD ANY OF THE ANOVN neeRle0b POL1:I1119 OC CANCILLGO NNFORE THE EXPIRATION OAIF'HEREOF. THE ISSUING COSPANY WILLGNUEAVOR 10 MAIL DAYS WRITTEN NOTICE TO TNF QERTIMOATE HOLDER NAMED TO TW LEFT, OUT;AILURE TO MAI- IUCH NOTICE $NALL IMPOSE NOOSLIOATION OR LIAVIUTY oFANY IanO UPON 7HEimA1rANY,D AGENTS Ort REFRN6W IATIVI& p m W W 0 C N a a a O ra z w a o G u w ,. a ci) a z z Q o w o c4 s U C w o to o 04 C o w o w LAO u U W 14 bo o cb cx c x a o a ¢ C7 1 M cG C ii w A a w cp z ? cn p E cn 0 H CDA2 .E O L a� s c O v CL CA O V .CL CA c 0 cc CA i O V O CL C/! c Co c O .c o -o CD m m 0 CLI) GD 0:w O oa d cmQ c 4-0� O OO z Q CL CA c LLJ 0 Cl) U) IrW W w U) c c m � :c c w o 0 C N o I C (� o. c ✓: m c I t o �.e-, N � D c CD 22 m Q o a C CD �•'C-. ' C7C ; 2 � o y A � C', cm C m c m y `O $ C \ N C y O (D CD v CD m ' m = S V L O B Qf CoQ f %J: ca m�� CO JAM N Zcc O . CD `m `moa N S M o apF- m LAJ LOS E a r C 0=�v, Z o C.2 `m om�c O g y 0. m 0:6 a y'- c _ v =�a,C� ` 0 H CDA2 .E O L a� s c O v CL CA O V .CL CA c 0 cc CA i O V O CL C/! c Co c O .c o -o CD m m 0 CLI) GD 0:w O oa d cmQ c 4-0� O OO z Q CL CA c LLJ 0 Cl) U) IrW W w U) Location f ---� Date -_r �- HQRTq TOWN OF NORTH ANDOVER F A " Certificate of Occu anc ,SSAC NUSlt'A Building/Frame Permit Fee $ <•�. Foundation Permit Fee $ Other Permit Fee $ TOTAL $� t• Check # ,; -Building Inspect r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: C DATE ISSUED: pe, 9a SIGNATURE: Building Commiss ioner/Inspector of BuNdings Date SECTION 1- SITE INFORMATION 1.1 Property Address: ?s' 1)2F57" sT, 1.2 Assessors Map and Parcel Number: a Map Number Parcel Number /• O L " A O V f 1.3 Zoning Information: Zoning District Proposed Use MTc1V J 1.FER M E LS o/l 1.4 Property Dimensions: Lot Area Frortta e ft 1.6 BUILDING SETBACKS ft Address for Service: Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided Name Print Address for Service: Signature Telephone 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 211 Owner of Record MTc1V J 1.FER M E LS o/l 2s- Fo 2,E s T sy" Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: 0 S U,�TTD/1� �T. Al �.�l �fi V )e �/� License Number ASO m 673 — 3 li. 0 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Ufa 1 r .6 A1 E RF6�, S D C7, / � Co mpany Name J b LL7-_8 N S, , p l p+ � Registration Number Expiration Date Si nature Telephone O z M 0 Mn z G) SECTION 4 - WORKERS COMPENSATION (bLG.L. C 152 § 25c(6) Workers Compensation Insurance athdavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check appUcable New Construction ❑ Existing Building 9K Repair(s) ❑ terations(s) 0 P Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ 9peciy Brief Description of Proposed/Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a licant ifpj;E. F4, RAVE s•ai ,.,...,,„N".. ✓d3Y t?8.,>•,'', "', .i ::$.'m. �z..z 4r '��',,r 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total.Cost of Construction 3 Plumbing Building Permit fee (81 X (b) 4 Mechanical (HVAC 5 Fire Protection 6 Total 1+2+3+4+5 SJ Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT T, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, DAV ti) CA -5-72 cl Cn Al E as Owner uthor ezi d Agen of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief C Print e _ Si ature of Owner/A ent Date 11,01,1111 NO. OF STORIES SIZE BASEMENT' OR SLAB SIZE OF FLOOR TIMBERS I ST2 ND3 SPAN DIMENSIONS OF SILLS DIMENSIONS 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 D, Robert Nieet#a, -81dif inn Commissieller TOWN OF NORTH ANDOV.E Office of the Building Department Community Development and Services 27 C.harles Street North Andover, Massachusetts 01845 DEBRIS DISPOSAL FORM telephone (978) 688-9545 FAX (978) 6)88-9542 In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit # the debris resulting from the work shall be disposed of in a properly licensed. solid waste disposal facility as defined by MGL c 11, s 150a. The debris will be disposed of at / in: (Site location) q11410 2, Signature of permit applicant Date 0 Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Diozzi, Gas/Plumbing Inspector W ct W v b p O w a v cn U ... A GG o � O U. u O a C U C w a 0 U � oa OW, dao p a: C iz a � W U W �°° O 92 v cn C w � C7 °° : O a: C w W d W w O = o u cn Q cn o mi _N Z H 32 O zipN C 0 7 O) m a cm C m O cm C C N m t O Z O �A f Co co L 0 V Z co C. O y G C W w+ a tmC I Q V ci ._ y c cc L- �_ CD Lft CD 0 C* L cc O a M: tmac ca Q ♦f..+cc ' C 'FL C2 CD C w CL V h c C C C _c 0. is 0 U) w w crw CO :o mcm :gym o cm 3 ; m C m O .a eQ y =c N R N O.V N m m C O Q mor CMJ.N Z � • v C �O H m : C N = m m w p� o H W C ; :S o L w LL H' Hm N c .QM C •d! cc LU .d O cm L3 4D ci O 00 Go a,..m mi _N Z H 32 O zipN C 0 7 O) m a cm C m O cm C C N m t O Z O �A f Co co L 0 V Z co C. O y G C W w+ a tmC I Q V ci ._ y c cc L- �_ CD Lft CD 0 C* L cc O a M: tmac ca Q ♦f..+cc ' C 'FL C2 CD C w CL V h c C C C _c 0. is 0 U) w w crw CO . ✓lam p ' - - 1 �-��-, Bard Of Bueldioade" g Re915 00ns:4ri& trNi7ard� NOh1E'MI ROVEMENT CONTE Y "+ .ACTC�n kQ9r,,ir4tion:',104Su9 cx;rrion /1%3%02 Tuna PRIVATE GOr�ORA'rON vVID CAST RICONE �tpOFi�G w. �+ salcooe 3 7 Wilfsra Ro d' Admin s 42, 3480 NORT►, F F SS US Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...�?.�. �. �... f'L U.t. .... ?'. ......... $ has permission to perform ,5x' Atft ne. S. ��r. plumbing in the buildings of ............... at. 7 , , . , .. �-NorthSAPkindover, Mass. Fee..?- ..... Lic. No. �J... .............� ECTOR m WHITE: Applicant CANARY: Building Dept. PINK: Treasurer K !j, (Print or Type)Check one: Certificate Installing Company Name VVHFFE RGGK PWNABING R HTG. Corp._ /&Oe 28 P.O.BOX 7 Address Partner. NUKINANE)OVER,MA. Firm/Co. Business Telephone 54- 2- C1 3Q 4 ""MASSACHUSETTS UNIFORM APPLICATION .I.FOR.PERMIT,--.TODo-,' UMBI G Insurance Coverage: Indicate the type (Type or Print) NORTH ANDOVER Mass. - D ate: Building Location 7:5 er- 0 if 5-j -71Y f f Permit [R] Other type of indemnity 0. �HCl I -A i4ndover Owners Name 7-O all�v- this application does not have any one iL New D Renovation I" Replacement Plans Submitted Ell %. FIXTURES K !j, (Print or Type)Check one: Certificate Installing Company Name VVHFFE RGGK PWNABING R HTG. Corp._ /&Oe 28 P.O.BOX 7 Address Partner. NUKINANE)OVER,MA. Firm/Co. Business Telephone 54- 2- C1 Name of Licensed Plumber: '26b Pj-+ Q 12C jt •P 14 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [R] Other type of indemnity 0. Bond 71 Insurance Waiver: 1, the undersigned, have been made aware. .that the licensee of k this application does not have any one N of the above three insurance coverages. %. * >- 0 a of 5d Z a) .-j -C W ccz a: X N =1 0 C3 z Cr. GL CC O; A Wl— 4a 61A X C** ix 1-. a la co cc U3iC o - 106 Z' W CC 0 C3 n lK 9) 4 id 93 3. a: Uj 0) Ck < a: *I j Ic 06 Cr. Cl J t4 jr UA 2: < us o CL CA z IL 0: o z z W M ". cc .11- > 0 0) 0 0 z a Q #.- -C 0 0 3: Y < J tu 01 in a A = < 1- A 0 -A W a cc :3 cc a W. -K 3 0 .&C -1C 411 I" Q SUIEL—BS114T. .1 BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4THFLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR K !j, (Print or Type)Check one: Certificate Installing Company Name VVHFFE RGGK PWNABING R HTG. Corp._ /&Oe 28 P.O.BOX 7 Address Partner. NUKINANE)OVER,MA. Firm/Co. Business Telephone 54- 2- C1 Name of Licensed Plumber: '26b Pj-+ Q 12C jt •P 14 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [R] Other type of indemnity 0. Bond 71 Insurance Waiver: 1, the undersigned, have been made aware. .that the licensee of k this application does not have any one N of the above three insurance coverages. %. Signature of owner/agent of property Owner E] Agenfllo I hereby certify that all of dke details and infognia lion I Isawc submi(Icd lot entered) in almlive application are flue and\rirtate to the best of uir knowledge and that all plumbing work and ins(allations lict(ornicd under rcentit imtsucd for WS application will be in compliance with Sig palinclat P10.4 visions of the Massalcitusetts State Plumbing Code and aLapter 142 of the General laws. B 2,La Title Signature of Licensed Plumber City/Town: S Tvgerj) of Plumbing License APPROVED TOFFICE USE ONLY) License Number Master Q Journeyman tr Ut Location %_>a No l/- � Date `5--/a 'yy TOWN OF NORTH ANDOVER Certificate of Occupancy $ `— Building/Frame Permit Fee $ Foundation _Permit Fee $ Other Permit Fee $ [� Sewer Connection Fee $ Water Connection Fee $ TOTAL $��� �U ,yU LTi X71 Building Inspector 7242 Div. Public Works W > O Q 7. I W 3 O U. O O W N a y a C n y WIr rc y LL O Z m y 0 f W W y m y y W m o IL O N y < pj y J J H IL O Z y W f IF y la _ y W a LK O FW- W W Z z u z O > m y z O x J U u D 0 1 II- x N d li s o W W V Q W 0_ tY w LL W z o 1 ; t /n r O P Z O I 3 y t,1 0 I IL 1 c ) Z z m O Z 1 fD OJ N W W I d J n y W y 1 1, 4i. f� � F A• � y~j Z J o `►W- W 1 1 f y W o W < z W a K W z lz ~ y o 0 J 0 J J Z O Z < y z O W LL U- O 0 r a W y a W y m W u W w I C W U z.z W U W U z O Q N O J Z\ Z J F F F W FAa U) a O O O 0 W z 0 LL 0 N N > W Z 1 u U. O < W 1- < o O O_ J 0z 0 Z 0 7 m y O F W z u Z_ O > m y O FW- W W Z z u z O > m y z O x J U u D 0 1 II- x N o W W V W 0_ tY w f o N ; /n O I < 3 y W < F z 0 Ir U. z 0 i oIL W � a W F y m O U u a o 0 0 U m m Z F M J W 0 O w tt 0 F F rc 0 U. Z O U U z a J m J J a O O O , z 0 LL 0 N N > W Z 1 u U. O < W 1- < o O O_ J 0z 0 Z 0 7 m y O F W z u Z_ O > m y O FW- W W Z z u z O > m y a F Z z u Z_ a > m m 0 O w tt 0 F F rc 0 U. Z O U U z a J m J J 0 C g v z z z O I y z I z O m� J m I u D 0 1 N o W W V W 0_ tY f N O (D U /n O I z i^ 0 � N 1 c ) Z z m O O 1 fD UA W W I y y y 1 1 F F a p o o `►W- W .___J-. 1 IL d S J i 1 �"" J J 0 0 NF m 1 W W u Wa < J U) a a W 0 C g v z z z m� W W V W 0_ tY O (D U O j � N 1 c ) 1 UA 1 E Pl W .___J-. 1 IL d .w....4 �"" I VIM I D n � m x N Z p-+�c op>0=�;w :EaT00 cn NNOp�yNmaD�on =00> A xEZ; r0 D m W vmnn N D ycl2 N .. rwmOD w ; zZZnn��AQ n�c�cnn yDp'°m vm D pnz0 NAr)n p�0 p O° = r N z z O p Z O O Z O O N O v-� N x Z A O c p m m _ D z� z O x J> n z z Z N N Z O O 3 Z A O ;00 z>> '0>> ;00000<n z�N y N ^' �� c << N m> ^' z z 0 G1 .- T > v A p T Z N z ~ D Z. o n _ Z� OaO ��m aOD _ C D�^ vm D y Dnx mODDO n p t0 ;TTT Omzz co�xv� z D Dz � C O N p v x D m p m x -� — O p C n x S o x n o Z " Z` > o T n = 0 D Z zx; Z O r) W �� A r Z O p zY _�; Y pb 2 m NN m n O Z! m N '� ; T N JC 2o -i y O y F Z Z X N m D m : Z O �L. yx O DD A sp � ZOp 2 N z p Ll I I II II II I IIw N_ I �� _LL1_L_i_I_I IIIII°' III!I I i IIII_IIIW ���� mr-i _ SON N N r N zm nNo D0 NZZ yam C :0X-1 D 11 n 0 0 in p3m mx -1zs =inn to z �z_ mN3 'D0z 'nN m0°O 0 Or v0 ic)r •000 DSD ?—Z =v 0-4 �D nZ In 00 D0 3 N 44:3 id4± I CERTIFY TO THE ANDOVER BANK AND ITS TITLE INSURER THAT THIS PLAN DEPICTS THE RESULTS OFA CURRENT EXAMINATION OF THE PREMISES DESCRIBED IN RECORD BOOK 1 C,03 PAGE 725 OF THEI/Or-1-77-4SEXREGISTRY OF DEEDS AND THAT THE PERMANENT BUILDINGS ARE LOCATED ON THE GROUND APPROXIW TELYAS SHOWN HEREGN I. THIS PLAN WAS PREPARED FROM COMPILED INFORMATION AND WAS NOT MADE FROM AN INSTRUMENT SURVEY. IT 1S NOT FOR RECORDING o PURPOSES. THE PLAN SHOWS THE CONDITIONS EXISTING AS OF THE DATE SHOWN HEREON. CERTIFICATION is FOR MORTGAGE PURPOSES ONLY. PROPERTY LINES AS SHOWN ARE APPARENT ONLY. 2. THE PREMISES DO NOT FALL WITHIN A FLOOD HAZARD ZONE, PER FEMA MAP 2-5,0 CD8 7�WEZ. /08 71.8 ZONE: G DATA L7 /.S -J Ulm! 83 l v I I I I I I 1' 1 THE PREMISES DID CONFORM WITH LOCAL ZONING SETBACK REQUIREMENTS AT THE TIME OF CONSTRUCTION. MORTGAGE CERTIFICATION SKETCH FOR 1�10MA LD E J EINE N / F'L=-,R— MCL S o/v 75 FOIL E S T S TPEE 1voYZ)-N . L)o vEr-z, n -1,A . S CA L E: /" --40' D A TE: PREPARED BY: KING ASSOCIATES 17 WILLIAM ST. ANDOVER, MA. Dvv(S# A 7 r CE NEWENGLAND WHITE PINE OR'TEX Sal p �t�tm PT %XVOMLMV20m wg ®R v n . Z; •r' -: " .,4 r-4 w acz x o w° cn E4 cn U z as c � w° a�' , c U w v z z ] a � c�° � w w U w w w°' . cn w p z � C7 � a�' w w A W ca 6 z V) o .� o cn W Cd c c :oma C N O O O �o v C.3 y��a� M C s � �yroo ` y rty+ > �y �d it ��Ea 3CDw %4% m ,o «_ Z Q , W c2 ilQ �z F m CL y 1►�t` o'L m ,o f * oa me . y R CD mm 0 m ��pp c J � m CIO M 'O t : ca C � 10 CD — y m m w'voi o c ao p� O �. y r0• m r0.. ~ UJ, x LLLJCO! v •y i. .may m }, Com. :F IML V J Go CD z_ E LJ A_ o ►•� 0 CDs ZCL CD co cm C O CO) O c Z .r= m CO z C:) o�Mi. Co O = c� E 4 10. U o .Q y �121 •� IS _ O i O ,:mo O Q O O 1-1 C%) HV Q L L H 2 � R O d w p o- �a �v U CO2 C c C cv O cm w i ► �p. O o J C4 co -a Z CO z O Q CD COD cm O C N _ CC O Q Cn Z O_ Q ~ z U2 Date. y. ...... .. ��MC� °` TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING o This certifies that .. Gt...... A -r r � `C Luc c< has permission to perform ........ .:.. G....... ........................................ wiring in the building of ......�. f...l..{.�.!.!.................................................... at ...... J ...........................?..7. �... ..�..:...........� ,North And M � s. G Fee . j.'. dv... Lic. No e;�� ..-?1;F1.1V1+..... ,�. ss��'� .. ....... ELEcrRICALINSPECTOR Check # / WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Official Use Only Permit No. bJ J ,MT Cow�v OW",tE,ALrDf 0T9I4,4SSAC9TVSET1S oepartment of Mfw Safety Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date Zoo To the Ins for of Wir Town of North Andover The undersigned applies for a permit to perform the electrical work described below`. Location (Street & Number �orZ�cS� v Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes No 0 (Check Appropriate Box) Purpose of Building_ 51,!� /P Utility Authorization No. _ Existing ServiceAmps Voits Overhead 0 Undgmd 0 New Service Amps Voits Overhead 0 Undgmd 0 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work j19961 �y No. of Meters No. of Meters OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES a NO = have submitted valid proof of same to the Office YES - NO = If you h checked YES pleas �q i e type f coverage b h king e appropriate box INSURANCE = BOND = OTHER = (Please Specify) CST—,�"0J �e�0 �/•t 01 (Expiration Date) Estimated Value of Electrical Work$_ Work to Start Signed under the Penalties of perjury: FIRM NAME LIC. NO. n c 1 it Bus. Tel No. v Address r aryl. OQ 0 124 Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware at the Licenses does not a the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) I-od- Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA No. of Lighting Fixtures Above 0 I Swimming Pool grad 0 gr 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Gond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No..nf Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No,' of Dryers Heating Devices No. of No. of KW Local Connection Low Voltage 4 of Water Heaters KW Signs Bailases Wiring No. Hvdro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES a NO = have submitted valid proof of same to the Office YES - NO = If you h checked YES pleas �q i e type f coverage b h king e appropriate box INSURANCE = BOND = OTHER = (Please Specify) CST—,�"0J �e�0 �/•t 01 (Expiration Date) Estimated Value of Electrical Work$_ Work to Start Signed under the Penalties of perjury: FIRM NAME LIC. NO. n c 1 it Bus. Tel No. v Address r aryl. OQ 0 124 Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware at the Licenses does not a the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) I-od- Telephone No. PERMIT FEE $ (Signature of Owner or Agent) 0 :J Date...... �.� ....................... 0 ` '• "� TOWN OF NORTH ANDOVER 1.00 p PERMIT FOR WIRING This certifies that S�G'L 2 7�//�� .......................................................................................... has permission to perform ......SEC. , �ify -?� ! E SYz?, 1 wiring in the building of / ' L ��� ................................................................................. at .... ��f................5�.......................... . . North Andover, Mass. Fee.. Y-5.7-. Lic. No. . .................. .............................. ....... d 9`S� LECTRICAL INSPE Check # —75` i Ma-mackude� a//,k I o f /�j// Official Use Only /�om.monweafiC' cC� L �7 �\7 Permit No. 2apartment of ire Service -4 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 (PLEIN ASE PRT N INK OR TYPE ALL INFORMATION) Date: l l - D-- Cityor Town of: k—)0, + To the Inspector of Wires: By this application the undersigned gives notice of his or her ((intention to perform the electrical work described below. Location (Street & Number) U C� �# :s - Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. -1 1,5 - (a - 1-f- % y U Yes ❑ No � (Check Appropriate Box) Utility Authorization No. Overhead ❑. Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters _ t'4T16r;1 01= �E.et:r l /c, 1—irc- -.,,n1-an nflhe fn llnwino tnhle may be waived by the Inspector of 1Vires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators K -VA No. of Luminaires., . Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency ►g ing Battery Units.. No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiatin ;Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices eat Pump Number I Tons o. of Self -Contained No. of Waste Disposers Totals: I Detection/Alerting Devices Space/Area Heating KW Municipal Local ❑ Connection ❑Other No. of Dishwashers Heating Appliances KW ecur' stems: or Equivalent No. of Dryers es No. of Water Heaters KW No. of o. of Si s Ballasts Data Wiring: No. of Devices or E uivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: j �' .t.� .oit by Iho IncnoMnr of 6{/irvc S 76-1111 Alrach auuluunut uctuu y Estimated Value of Electrical Work: �� (When required by municipal policy.) Work to Start: Ot-a--e-p, 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 Q BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: ka�, SQ Luf i S -c r es LIC. NO.: -LISC Licensee: M Af iL.Signature LIC. NO.: mise, (If applicable, enter "exempt" in the licen umber line.) , Bus. Tel. No.: %U 3 �4 5�a? Address: (i C 'L I Y1T Gm - r. % \ s _ iJ N O 4 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. C)a 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 ❑ own is agent. Owner/Agent PERMIT FEE: St Signature Telephone No. (f wn-weaR of Mamackuselfa Official Use Only c� Permit No. 2Jiro of Service9 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Ll o'�- City or Town of: KDOr^+k OA_o-t>__ 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) fl -,5:--- p (',e `��' `— Owner or Tenant O t Telephone No. `�J 7 F Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity i Location and Nature of Proposed Electrical Work: U Yes ❑ No U (Check Appropriate Box) Utility Authorization No. Overhead F]. ❑ Overhead ❑ Undgrd ❑ l `e,+I CY) 01= No. of Meters No. of Meters ?a t / O r- t -Ire Completion of the following table may be waived by the Inspector of {Vires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans r o Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Aboven- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas BurnersTot No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices eat Pump Il_No. Number ons o. ofSelf-Contained of Waste Disposers P Totals: ............. 1___ �� � � �. ... .... ....... ���� � �........... Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal Connection El Other No. of Dryers r7 Heating Appliances KW ecur' stems: . s or E uivalent No. of Water KW No. of o. of Data Wiring: Heaters Signs Ballasts I No. of Devices or Equivalent No. H dromassa a Bathtubs Y g No. of Motors Total HP a ecommunications Wtring: No. of Devices or Equivalent OTHER:) T1 - Attach additional detail iJ desired, or as required by the Inspector of wires. Estimated Value of Electrical Work: o" Z SD a, (When required by municipal policy.) Work to Start: CL -a-4-# 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 Q BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: 0a) Sf ,u r S -c r e LIC. NO.: -J-I`�C Licensee: mGf i� �Y(-)jDh l Signature LIC. NO.: SC. (Ifopplicable, enter "exempt" in the licenseJnumber line.), Bus. Tel. No.• (GU 3 N �a� Address: l S' C L, I r)—% c -n !� r. %� 1 t S . 1J N O 3 0 i{ Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OLX7 1�� 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 ❑ own is agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. Ic e pr CD C) OO = p CO=.A D Ln COO O CO h o r+ Yj(nl a C s 41 ry r C r .t -n W w O a n {o na oda o 0 m oM a cn 0 en CD Z r 3 D m x z c c 1 3 O Y a d D D no> o not y m o n z cn 0. O Cl) Z M C 10 z` o O a m (n 0_ O 3 t7 M n —fn O „(� cn \\ _M 7 cnmc mm z„ g mzz mr m M a, T m cn'U-i Nan D m { "{=G� o c p w -<;a m P a W a cn m �< (D -•fin O -"� o ' a - Y c �� AFD m N - _ V o ' Nn rn Z n cn d o N M i N �_ n W I F-1 z a 0W c 4 En M of N cn i 1 Signature L Ic e pr CD C) OO = p CO=.A D Ln COO O CO h o r+ Yj(nl a C s 41 ry r C r .t O a oda 0 oM a cn 0 en CD _ -c N C m x z c c N O .� 3 -• CL cn p m , m D D no> o not y m o n z cn N O Cl) Z M C 10 m o O O 3 P w C e H o cn \\ _M 7 _r t7 A 1 M a, T m { O p Q a m M o ' a r r A M ' z M i V'