Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 770 SOUTH BRADFORD STREET 4/30/2018
N -4 r O o cn O v 60 0+ 11 N O b v o o m Location 170... -Se No. ^� Date 'y �8^U Z K A" TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ; -- Foundation Permit Fee Other Permit Fee TOTAL Check a / L 5/ i 15454 / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLIISHH ONE OR TWO FAMILY DWELLING .A A.C,w.:�ty"`i"` ._, BUILDING PERMIT NUMBER: 01, DATE ISSUED: SIGNATURE: Building Commissioner/IndtWor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 720 SCt I54AD&PeD Si 1.2 Assessors Map and Parcel Number: .0. y �:)— Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record _-roM j- Kd,-r4j 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 License onstruction Supervisor: ?q.y[ IT stlult+yry Licensed Construction Supervisor: 2 Z D rr— /�'% o1837 -License �G�sB'� � f �Hu�d�Fi�c. ddr s Poo 37172 3�' Signature Telephone Not Applicable ❑ on 3^C Number Expiration Date 3.2 Registered Home Improvement Contractor S�4w►J9 A -S Aft ug Not Applicable ❑ //3 91 Company Name Registration Number Address Expiration Date Signature Telephone U0 M Z O M 0 i SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) 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 .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: POA 4,6±[ RWM —h QMC(p I SECTION 6 - F.gTIMATFD CONCTRi1rT10N COCTC I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY I . Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Gb0.6?! Check Number SEC HUN 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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, as Owner/Authorized Agent 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 k. Print Name Signature of Owner/Agent Date OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS 1 2 ND 3 SPAN DIMENSIONS OF SILLS DIIVIENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 14 Date., ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING v Thiscertifies that....C'......................................................................................... has permission to perform ..... .......................................... � O wiring in the building of .....1^............................................................ 1. �'�PAIjP..... , North Andover, Mass. at ........... .....................................................! Fee... ; ..... Lic.No. —P 5�......t.:E.&:4—h.AM.!.(.�?-`,:.. /� Q ELECTRICAL NSP CTOR Check # G49 v 5632 J '. Commonwealth Department BOARD OF FIRE PFS Vf �LJ1 APPLICATION All work to be cerfor (P.l F,1S.E PRINT . Arfl _K 0 City or Town Oga By; his application the undersi Location (Street & Number) Ow aer or Tenant __h9_X_ Ow ner's Address O MassachusettsF O�cial Use Only f dire Services NI7ION REGULATIONS d Fee Checked _� I No. of Lighting Outlets"No. IeavebIank tedOR PERMIT TO PERFORM ELECTRICAL WORK in accordance with the Massachusetts Electrical Code (MEC), 527 CMP.12.00 A' �'O TION) Date: O1ca.�t`� it LO 9 Q To the Inspector of 13�ires: is notice of his o her ii'ntt\eention t{/o� p rform the el tri al w rk described below. Telephone Na _5x_6%1 -0"9 Is this permit in eon ju:rction with a bonding permit? Yes 9-1-, No ❑ (Check Appropriate Box) l?ur pose of Building Utility Authorization No. Existing Service klub Arips \O -W !A_p'yrolts Overhead [D'_ Undgrd ❑ No. of Meters Nevi Service Amps / _ Volts Overhead ❑ Undgrd ❑ No. of Meters Number ©f Feeders and Ampacity. Loc%flon and Nature of Proposed Electi ical Work: O w� -- No. of Recessed Fixtures �� ....,,. •�=wu v croc auumn No. of t"eil: Susp. (Paddle) Fans 'ITransformers cuoce may oe waivea me _ns ector o Wires. o. of ota KVA No. of Lighting Outlets"No. of Ilot Tubs Generators ICVA No. of Lighting FMx ores 11iwimming Pool�bove ❑ - ❑ o. o mergency ig Mg rnd. grnd. Batte Units �No. of Receptacle Outlets l r1o. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 'I) { --- - ---- No. of Eras Burners _ o. of DetecdFri an � Initiating Devices iNo. of Ranges 1670. of Waste Disposers No. of Air Cond. To Tons heat Pump umber Tons KW _ No. of Alerting Devices No. Self Totals; of -Contained Detectionw/Aallertfine No`A Dishwashers Space/Area Heating KW '7. Devices umcipa Local ❑ Connection ❑ Other No. A Dryers Beating Appliances KW Security ystems: No- of Devices r No—. se Beaters KW ater`� or Equivalent Data Wiring: Signs Ballasts — ig No. of Devices or E uivalent I�'cr. i:Iydronaassage Bathtubs iz'o. of Motors Total HP Telecommunications iring: — — (1 ---� No. of Devices or E uivalent I €iTI CER: S V IC n Q _ Attach additional detail f desired, or as required by the Inspector of Wires. LNSU EiANCE COVERAGE. Unless wai"•ed by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insui ante including "completed operation" coverage or its substantial equivalent. The under;ipr td certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE I BONL) ❑ OTHER [i (Specify:) Estim tted Value of Electrical Work�(Expiration Date) �� ___` (When required by municipal policy.) Work to Start: inspections to bet requested in accordance with MEC Rule 10, and upon completion. I certi§7., under the ants and pen `a`llies of perjury, that the information on this application is true and complete. ERYI NAM' fAt r`, Syy. U-, LIC. NO.: kookoD �SZ Ucen;ee:1��„ ��� �_ Signature LIC.NO.: �SD$Ll ,7f app, icable, enter exemp'" in the 'icense num her UaajBus. Tel. No.• °l7Q Sbei - 3 S3 Addrt ss: vo GD\i a L ( "K _ n SJ l� `6 Alt. Tel. No. i - 3-A3 OWN ER'S INSURANCE WAIVER. I at.1 aware that t e Linen ee does not have the liability insurance coverage normally equir(Z by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owne /Agent --- Signaiure _ __ Telephone No. [PERMIT FEE. $ f 7, Robert Nicetta, P1rsilrfing commissioner TOve N Ota NORTH ANDOVER Office of the .Building Department Community Development ind Services 27 Charles Street. North Andover, Massachusetts 01 845 DEBRIS DISPOSAL FORM Telephone (978) 688-9545 FAX (9-18) 688-9542 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: /r 6 LG CI�O.P$t£ %c�td N b4A ' (Site location) Signature of ZE Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Diom, Gas/Plumbing Inspector %7.e �%ome�rzo�rureaiiiz a�',.�t�rk:ac�uorltd $oard of Building Regulstions and Standards TRACTOR HOME IMPROVEMENT CON Registration: 113091 Expiration: 05,117/2003 Type: Individual PAUL J SMUTNEY PAUL SMUTNEY 220 WILSON ST HAVERHILL, MA 01832 r�d�tor BOARDNBUILDING S RUCTION SUPERVI TORS OF License. C 017391 Number. CS Birthdate; 0112511946 14295 Expires: 01125/2004 Tr. no: Restricted: 00 _ p PAULJ SMUTNEY -h 220 WILSON ST 01830 Administrator HAVERHILL, DENCO ENGINEERING, INC. . Structural Engineers t PROJECT.: Ir/'E"Z�.IT 6 p r� PROJECT NO. SUBJECT: TAMS DATE • 1 Z t - g? 2. CO 2002 DENCO ENGINEERING INC. SHEET NO. 2 OF Z. '#aC f k JsrS. Por- " x C (G S I' L , D ae ►,' S 3 n�',o /,3 ,� 3,2s s z�� U (pro µsx,=Zs•ff 37Vx & zt� - - 310 3�y ►.� /4x� every 3 Sats 5�Aj 32� 3, Zee 3��� r v �452 76& 2o,Zx 12. eS0 5z4M32,s'' W I r~.x2Go 4 iERED STRUCTORAL ENGINEERS r�R: ASCE, SEI, AISC, ACI, CSI sACHUSETTS ---- 08669 'W HAMPSHIRE____01196 DENCO ENGINEERING, INC. L'ONNECTICUT ------ 07487 STRUCTURAL ENGINEERS NEW YORK --------- 37301 VERMQNT---------- 02009 MAINE ------------ 01 519 148 PARK STREET PROFESSIONAL ENGINEERING SERVICE SINCE8 NORTH READING, MASSACHUSETTS 01864 1 95 (978) 664.6733 (781) 944-8440 FAX (978) 664-9233 PROJECT: -±11-a. / cl. PROJECT N0, d `t�Z• !V__ jlNon CLIENT: gy; DATE: I'"T/-Cad, �; V yF� tivt.. REVISED: REV. DATE: SUBJECT': �,�A�,,� SHEET NO. ^OF_ C� 2002 DENCO ENGINEERING INC. �?eQ r- r2i ci r p S t'A, xi X 2 2 24o .. CREAM 2D 12 z gF-4D4./ -5 2 Z ge* a 6sz� M _ i 14. r = 2 0q0 zeoe� • = 3 3 �1 2 -11 u 114 LVL 2-l3gk'�� LVL T+K► su��a2r 1J©�► .l,wr,� PD-s?9 �PA4 2nga -cam 2'G. l�okll= G�Gta� 73 1�c7 $03 l�37 1 `P31 2., 5 . cJ..643 9ga&, t- 20,o LVL m Permit Number MECcheck Compliance Report Checked By/Date Massachusetts Energy Code MECcheck Software Version 3.3 Release lb Data filename: C:\Program Files\Check\MECcheck\ferlito.cck TITLE: FINISH ABOVE EXISTING GARAGE CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 04/03/02 DATE OF PLANS: 2/26/02 PROJECT INFORMATION: TOM & KATHY FERLITO COMPANY INFORMATION: SMUTNEY CONSTRUCTION 220 WILSON ST. HAVERHILL, MA. COMPLIANCE: Passes Maximum UA = 138 Your Home = 125 9.4% Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA Ceiling 1: Cathedral Ceiling (no attic) 704 30.0 0.0 24 Wall 1: Wood Frame, 16" o.c. 846 15.0 0.0 57 Window 1: Wood Frame, Double Pane with Low -E 102 0.300 31 Floor 1: All -Wood Joist/Truss, Over Unconditioned Space 384 30.0 0.0 13 Boiler 1: Other (Exept Gas -Fired Steam), 80 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.3 Release lb and to comply with the mandatory requirements listed in the MECcheck Inspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. W co OE: im O L O N �p O cat.') c 0 R ea o � 1m s Nom-' :Ea �• of C .. ID ..s E c �C L P o' CJo S ca : CD m c L O N m 3 •• c C � J : m ev o N T N C* CA m ✓: C3.- Z .. IL O e2" -a cm r C CLO C Q � y m O •O = m Q:m� 3 N vi m ��, ~ m t W C O •N dt O C Z LU 'E Q=N ci o C.3 4D N_ CL m � O: Z m o a C z 0c$m A -r CO)cm p 'O co y CD m m CCDO CL CD CD O C O L oa CL O! Q C O= C ev V CO3 Z Q CL C u CO) c C — C _c CL CO3 0 U) U) irW W W U) O w v v) ° a O w O .� U C x a w X. a P: Cr x a c:4 G w" z w a cza cn Q O cn im O L O N �p O cat.') c 0 R ea o � 1m s Nom-' :Ea �• of C .. ID ..s E c �C L P o' CJo S ca : CD m c L O N m 3 •• c C � J : m ev o N T N C* CA m ✓: C3.- Z .. IL O e2" -a cm r C CLO C Q � y m O •O = m Q:m� 3 N vi m ��, ~ m t W C O •N dt O C Z LU 'E Q=N ci o C.3 4D N_ CL m � O: Z m o a C z 0c$m A -r CO)cm p 'O co y CD m m CCDO CL CD CD O C O L oa CL O! Q C O= C ev V CO3 Z Q CL C u CO) c C — C _c CL CO3 0 U) U) irW W W U) 1 Location '71) ' No. Date NQRT" TOWN OF NORTH ANDOVER 3? ` 6 0 AL � n Certificate of Occupancy $ ;�s • Eta Building/Frame Permit Fee $ sACNUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I`�` _ Building Insp6 ctor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE,OR DEMOLISH A ONE OR TWO FAMILY DWELLING C���� i�� ., and"04A E-Vlil Vaf __ BUII.DING PERMIT NUMBER: DATE ISSUED: J 3� 3Q/� -dv� SIGNATURE: (6.4� Building Commissioner n for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address:1.2 77t) s . 4 �F+1)rQAJ � � Assessors Map and Parcel Number: 10q-01 Map umber Parcel Number JV,/„ j&D0V5a.r My 0Io4 V� 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required —+ Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal )l on Site Disposal System ❑ SECTION 2 -PROPERTY OWNERSIiIP/AUTHORIZED AGENT �I:lafjc: ri triCt: inn P,jo 2.1 Owner of Record C^ y • AS h�/-1 7-0 r1f�G r Name (Print) Address for Service : Signatltre Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: at,w,�/�"W&T—Sym 9, lG`L %"4W Licensed Construction Supervisor: /���o m4 a,2wz dress ,n C 7,f- 7 %O' S`f-414 Sig ature Telephone Not Applicable ❑ p '79O 3 License Number � - 16-05-no's- D Expiration to 3.2 Registered Home Improvement Contractor IL-yS &KwF �ysr s Not Applicable ❑ 13 / 9�`3 Company Name 7SWPi,t 1114 GZaL/ Registration Number Addr s % •�� fi%G Expiration Date Signa re _ J Telephone 00 M z O v rn W lig q 0 z M 90 C rn Unlessz 0 SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 25c(6) 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 .......W No ....... 0 SECTION 5 Description of Proposed Work check aIl applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) SY Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: - 64IN 6S6W1WT CV 177 f j [W& d Co e " &OV6 T r,,,VLQel 2 `x 2-" kaP C'etuiyGBrArw SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OMCIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 7.Mei I-ao* 6mew i5GKL/1D as Owner/Authorized Agent of subject property Hereby authorize //!!r//�✓SG-Vov,,6 A 4- , sys/,! 5 n to act on TMy behalf, in all matters relay e�tq work authorized by this buildurg permit application. _ Do .— /_�� 3- 2-0 S Signature of Owner Date SECTIOON 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property 770 S. A*YvW 5�- Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print N 3 Z -Or Signa6e o110wnq4VftW,,f Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2-''u3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GUIDERS HEIGHT OF FOUNDATION _ THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED I:AND IS BUILDING CONNECTED TO NATURAL GAS LINE aq WN s cI m � w �0N� 0. '0 o c o3 m .x � = N O � n N O y 0) ((D ISD 7 7 n ID OS fEP w O O S Q N (D O N N N x• CL w O z w N SD . C O 0 w a n 0 CD 11) p Q 0 N _ CL x 7 N 0 C S 401 0 oo w 2,3(c O O 00 0. v 4 m SOCA International Evaluation Report description OWENS CORNING Basement Wall Finishing SystemTM is an alternative to conventional wall framing and gypsum wallboard. The Basement Wall Finishing SystemTM consists of PVC support lineals, base, batten, and cove mold- ings, and rigid prefinished fiberglass panels Panels are prefinished with a fabric cover. Basement Wail Finishing SystemTM is primar_ ily intended for installation in residential applications. Refer to Figure I at the end of this report for illustrations of the Basement Wall .Finishing SystemTM. The Basement Wall Finishing SystemTM shall be installed in accordance with the manufac- turer's installation instructions and this report. Installation typically consists of either me- chanical fasteners or adhesive fastening or a combination of both to the supporting sub- strate. Thermal resistance (R -value) for the fiberglass panels is 11. Basement Wall Finishing SystemTM panels meet the requirements for classification as a Class I interior finish as tested in accordance With ASTM E84 and also has demonstrated that it will not spread fire to the edge of the specimen or cause flashover in the test room .in accordance with the testing requirements specified in Section 803.6(2) of the BOCA National Building Code/1999. condition of use This report is limited to applications and Products as stated herein. BOLA -ES intends that this report be used by the code official to determine that the report subject complies with the code requirements specifically addressed, Provided that this product is installed in accor- dance with the following conditions: • OWENS CORNING Basement Wall Finish- ing SystemTM is intended for finishing walls in basement applications. Other applications are outside the scope of this report. The maximum permitted area of the PVC moldings shall not exceed 10 percent of the aggregate wall and ceiling area of the room. Installation of the Basement Wall Finishing SystemTM shall be in accordance with this report and the manufacturer's installation manual. Basement Wall Finishing SystemTM shall be installed over cast -in-place concrete or concrete masonry unit walls, or wood or metal stud framing. Supporting structural systems shall conforming to code require- ments for that system and are outside scope of this report. • The electrical wiring in the chase at the bottom of the Basement Wall Finish Sys- temTM shall conform to the requirements ofs the code and is outside the scope of this report. Items requiring verification The following items are related to the use of the report subject, but are not within the scope of this evaluation. However, these items are related to the determination of code compliance. ✓ Concealed electrical, mechanical, orplumb- ing components shall be inspected prior to the installation of the Basement Wall Fin- ishing SystemTM panels to verify compli- ance with related code requirements. Evalu- ation of these components is outside scope of this report. ✓ Framing supporting the Basement Wall Finishing SystemTM shall be inspected prior to the installation of the panels to verify compliance with related code requirements. Evaluation of this framing is outside scope of this report. AL .RM 0 lip c AII�IC- Researeh Report 21.24 MANUFACTURER: OWENS CORNING ONE OWENS CORNING PKWY TOLEDO, OHIO 43659 DIVISION 7 — THERMAL AND MOISTURE PROTECTION Section 07200 — insulation DIVISION 9 — FINISHES Section 09540 — Special Wall Surfaces EVALUATION SUBJECT: BASEMENT WALL FINISH SYSTEMTTM PRINTED AUGUST, 2000 Page 1 of 2 Copyright© 2000, BOCA Evaluation Services, Inc. A Participating Member of the NES, Inc. Page 2 of 2 Research Report No. 21-24 informati on submitted ■ IntegrexTM Testing Systems, Report No. 73143, dated April 17, 1000, containing results of physical testing. ■ IntegrexTM Testing Systems, Report No. C423-99065, dated August 19, 1999, containing results of physical testing. ■ Omega Point Laboratories, Report No. 13060-10321.6a, dated May 14, 1999, containing results for fire testing in accordance with ASTM E84 for rigid fiberglass wall panels used in Basement Wall Finishing SystemTm. ■ Omega Point Laboratories, Report No. 16218-106644, dated April 13, 2000, containing results for fire testing in accordance with ASTM E84 for moldings used in Basement Wall Finish- ing SystemTM. ■ Omega Point Laboratories, Report No. 13060-103213a, dated June 7, 1998, and Report No. 13060-104470a, dated March 24, 1999, containing results for fire testing for full-scale room cornea resting in accordance with requirements. zontained in Section 803.6 (2) of the BOCA National Building Code/1999. ■ OWENS CORNING Product Literature, dated May 1998. ■ OWENS CORNING Submittal Sheet for Basement Wall Finishing System (BWFS), dated April 2000. • OWENS CORNING Basement Wall Finishing System Installation Manual, dated January 2000. aopiication for permit [d in the determination of compliance with this re following represents the minimum level of informati n the accompany the application for permit _ ■ The language "See BOLA Evaluation Services, Inc. Research Report No. 21-24" or a copy of this report. ■ Plans indicating the aggregate area of the room and the area of the PVC moldings being used. ■ -Plans and specifications of any electrical, mechanical, or plumbing items installed within the wall system. product identification All OWENS CORNING Basement Wall Finishing SystemsTTM manufactured in accordance with this research report shall bear the following identification: • "See BOCA Evaluation Services, Inc. Research Report No. 21-24." All Molding Snaps into —4 PVC Support Grid 2.5" Glass Fiber Board Panel with Facing PVC Support Lineal (top. bottom, vertically every 48-) Existing Foundation Wall or Interior Partition PVC Cove Molding PVC Molding Vertical PVC Batten Molding Base Figure 1` Sketch of Basement Wall Finish SystemTM Showing Typical Components ■ Details and specifications of the supporting construction to -THIS DRAWING IS INTENDED FOR USEOAS A CONSTROUCTION URPOSES ONLY. ITIS NOT DOCUMENT which the system is to be applied. PURPOSE OF DESIGN, FABRICATION OR ERECTION. FOR THE NOTICE TO REPORT USERS This report is subject to annual certification. Reports that are not certified shall not be used or referred to. To determine the status of certification of this report, contact BOCA Evaluation Services, Inc., or consult the latest edition of the BOCA International Product Evaluation Listing published Periodically in the BOCA Magazine, or call the Fax -0n -Demand Service at BOCA, extension 500. This report is subject to the conditions listed herein and to the specific product, data and test Independent tests were not performed by BOCA Evaluation Service.-,ce submitted t the applicant requesting this report. or implied, as to any findings or other matter in this report or as to anyroduct covered b this reporL Evaluation tally does not make any warranty, either expressed representing aesthetics or any other attributes not specifically addressed nor as an endorsement or recommendation for the u of to report subj�� TMis t. disclaimer includes, but is not limited to, merchan,tability. e contact BOCA Evaluation Services, Inc., with any questions you may have regarding this report. Additionally, phase contact us if you have any information on the performance of the product described herein which is contrary to this report. 4051 West Flossinoor Road • Country Club Rills R, telephone (708) 799-2305 60478-5795 fax (708) '9_0310 P-r"nill. 11n!`4 -0C ..w,. - i_��_- 11 �\k2 §$%sr 0 7Q EP 0 [�[( # 0 CD §(0Er \�C 0 _ \(/\ a®kg cn 00 \\0 0:197e3518eao ALibe Liberty Mutual Group utuo. POlim 7202 POrismouth, INH 03802-7202 Tdephone (800) 653-7893 September 22, 2004 Fax (603) 431-5693 FOR RECORD PURPOSES ONLY RX. Certificate of Workers Compensation In. insumd: BAY STATE BASEMENTS LLC DBA OIWENS CORNING FIN ISHED BASEMENT 960 TURNPFKE ST P-J,Iicy_Number- 4VC5-31S-?dl)59-014 >rirccave: 5124/2004 Ekpiration: 5 /24120(15 Coveruge afforded under Worries Compensation L'at"f rite fOIJowing stste(s) Lntplgtilcrs Liability MA Bodily hyufy By Accident: s 500.000 Each Acciclem HodilY fajun, by Disease: $ 5(10,0(1(1 Each Person Budily Injury b}' Disease: 5 500.0011 Policy Limits Ac of this date, the above- referenced policyholder isnsured listed above iby "A' Tnsmataae CarPoradott twder the, policy "lie insttr111ce afforded by the fisted policy is snbiect (o all the terns, "ciusions and conditions, stnd is not altered is andregnlreman_ txm or condition of ally or other docutuents tt�ith rcspW. to which this certificate rf�ar be issuod. "his oeriifrcato is Issucd as a ou't'er of information qtly and m» fcrs no ribrit upon You. (Ire oertificatc certificate holdor. POlic, listed above ficate is not an insurance Dolicv and does not axttetul, C.\Imd, or alter the coverage a>iorded b5' We If tit's policy is rmcelled before the 90tod Q*ratiOn date, Liberty Marlin' Witt endeavor to notify you of such c ancellatlon. n� ntlusttt:u rt�:rla�.'celv'rnrtvr. t 3llLR'1 Y 1�[ BTU AL IN6l IkAA1Ci. CtiiUUt' l r•,'util7nyu u,n�, I.nM1VM!rn!N.rNHt!R.1NCii 4RfK!Pwry,rl+udr arch' io-n v.r, r. m'I oralcoh (!Nr.Y WI11r.M1RK CC. i "UI ea, DAY STATE 6ASEIVMN7S LLC DOA OWENS CORNFNG FINISHES) AASEMENT "01) TURNPIKE ST Wz•xn. nm�tl:�:'�� Rnnr�1 A\'DRF?W C GORDON INC P0Box 299 N01 -WCL -L. MA 020!,1 P. 1'1 r f -r- SEP 3 0 2004 91?e -� Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 137943 Type: Supplement Card Expiration: 129/2007 OWENS CORNING BASEMENT FINISHING DANIEL WALSH 960 TURNPIKE ST. CANTON, MA 02021 Update Address and return card. Mark reason for chang PS-CA1 !'i 50M -04/04G101216 Address [:] Renewal Ej Employment E] Lost Card G.T� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 137943 Expiration: 1/29/2007 Type:; Supplement Card OWENS CORNING BASEMENT FI 960 TURNPIKE ST. CANTON, MA 02021 Administrator 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 signature m m m m m y d C 57 CO)CD a y d O �• C Im =r C y aCO -0 �C* CD o p O Q �dCD CD o CD CD co) CD �O y CD I A C/) Mum z � m (A CD bj cl 0 - o CDcl CA 0 0. O � p sem. A cn 0 C 0 S y-1 ELp S o CA y CL O aw O m ti CD H0aC � m o o cp o aim o y y O O Err O p m = > > D G a GO CD x = O 0 d �' o. m CA CD C 0co C c. d m : H c 01 y N CL O' N m CD CA CD 0 CT y 3 FW ecop.� bt p y3 o Mum z � m (A CD bj cl 0 - o CDcl CA 0 0. O � p sem. A cn P. o �� o � o � � o o cp GO ro x �'' r� c ii om, O C ►s 1 Location No. Date TOWN OF NORTH ANDOVER Check # s� 0 174$9 TOTAL ,/ Building Inspector Certificate of Occupancy $ �+s �•^� E<�' S4CHU5 Building/Frame Permit Fee $ v Foundation Permit Fee $ r Other Permit Fee $ Check # s� 0 174$9 TOTAL ,/ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI& RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING A BUILDING PERMIT NUMBER: O c/3DATE ISSUED: % _ oZ / ` 0'/ (6z" SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 9910 S.- _ /s' Map Trumber Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) . 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1-tsturic District: Yes —Nu 2.1 Owner of Record ;i Hyr'745 innlzc Name (Print) Address for Service 1 Q. Q/,V)-D Signa6e Telephone 2.2 Owner of Record: Name Print Address for Service: f f 64&&A�S— Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number 41'2 13 i,iD S S 0J-1 5,^--f 3 f r� r';oA,0 Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Not Applicable ❑ /Contractor rZ ?„ Y Company Name Registration Number Address �l ? 0.3 9:S'9 (2i Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) 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 .......❑ No ....... 0 SECTION 5 Description of Proposed Work checkall applicable) New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATFD C0NSTR11CTT0N COSTR I Item Estimated Cost (Dollar) to be Completed bpermit applicant OFFICIAL USE ONLY 1. Building _ (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (.) X (b) d 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number JL' 1;11UfN /a UWIVEK AU 1HUXILAILOIN '1'0BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, r Z l � p L 14-e-.QD iX 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 r, as Owner/Authorized Agent 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 Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2 ND 3 RD 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 0 LO?' ZZ �1uQ�O7,3 SF z - - c3S'9.9(9 A L �2 .v XE -&K C•eM,-Y To 7h- r/TGE /.US!/.e W 4 50 P4,4...v TD 7AW 6,41VIV rV47 r ll - A*IC44/.v6 /S LOC.47E"G ON r//E nor qs S,PVV A.VP ;-1ar/roaES cowl-ael/ /A/ Aylra fmN- TOwAl OF /,0 A^10 vz zO www ,-E6vLAT.OWS ,PEG.I.eO/.✓!a .fETQgC.t'S .FEO�tI SrCee-,7,LOT L/NES N J,/O/2191VIObvC/2 /-/A5s . �s .'Y/,criYG.0 CeA-r/FY' 7W.47- TN/.S OA -V -e -Mla /; NOT l�.f'.9i�iV ,comeLnGQTEO /tet/ THE o-4r4wP44 F,000LI •.i.42AP19 APER. Lsvdow" o/V FEM�a Mu viTY P•I.n/�� 10r Z 5CX��fg 000 7G AP Expo`%, r, z - 9 3 1.4 S• t s. S r �\ STEP , SPC. S. A E 7O4e1A PLAN A107- FOP BOU,t/O.P'/ Lam" /O� BOUNOA.PY /�(/FOif'�1•l' grivv rA,rE.y F,�O.Y! Exrsr�.(/c ,eEca,�os. 6� i'q.P,(� .S'T.fEET Flo - 23S A.VOOI�E�', �YJ,4S.S,4C.��/S�"TT.S O/8/D 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: (Location of Facility) Signature of Perrf'iit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Zko e Zxq p,�- i�01-7-01'1 PW' t/ ; Ole, t CUSTOM CABINETS CUSTOM PINE FURNITURE FORMICA COUNTER TOPS ORDER FORM ill, d4# R. 2 ctoiz GENERAL REMODELING & CARPENTRY SOLD TO SHIP TO ZH �4v Aej J l�r53V y QUANTITY STYLE NO. DESCRIPTION A • , F 9 I� 11111111/ M1. I PRICE I TOTAL 47 Blossom Street Bradford, MA 01835 508-373-4817 14 Newton Road Plaiston, NH �/�/�y / //603-382-1389 r DATE TERMS ORDER NO / / DEPT. SHIP VIA SALESMAN I� 11111111/ M1. I PRICE I TOTAL �iie �anrmwvuuea/,C�i o�'✓f�avaac/auaella t BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 000795 Birthdate: 05/05/1950 Expires: 05/05/2006 Tr. no: 23885 Restricted: 00 PHILLIP R LACROIX 47 BLOSSOM ST HAVERHILL, MA 01830 �i Commissloner f �iie �iomvnzaieu�eal[yt o�✓�iaaaac`usael�a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration, 102841 Expiration: 7/3/2006 ` Type Individual PHILLIP R. LACR0IX ` S , 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 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 000795 Birthdate: 05/05/1950 q Expires: 05/05/2006 Tr. no: 23885 s Restricted: 00 PHILLIP R LACROIX 47 BLOSSOM ST HAVERHILL, MA 01830 t Commissioner r T1.0 Board of Building Regulations and Standards, HOME IMPROVEMENT CONTRACTOR Registratioir 102841 Expiration 7/3/2006 Typed Individual PHILLIP R. LACROIX 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 m u _v, y d C .0 CO) CM) CD az y CD 0 CL � c O y aCO -0 CD su o p CD CD o CL cr d =r CD o CD mm CD y. av y �■ O CD I o C• NJ O CS H = D O CD 40 F CL C2 m Z h m .-► C ="C h �1 =r0 4=0 = CLy CCI O O CA O IE m m a > > CA f _ .� O N O m -�� --cO 0 �ZCD acot :_ ♦ :0 CL = � 8 Cn„ mOH:S ` 'd CD c co fA CD / 0 Op� y e•,• Z H O 2 m=Cr CO: 0 n lb CK bpm: `� ♦y4F4b o=mom C/) O y� H z O O 7 � 32, n oCD P CD smCAi Ir n .14i 1 0=3 0 9 ZI lO Z, (A (n Cc ter] :r o CrJ�' o 0'- o Or � r cp �i. Date:-A/0/ ate A /0/�� .... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ° HU- - ,�, Thi certifies that . % . f � ..� ...... .... . /� ... 7` has permission for gas_installat-i9l ... in the, buildin s o f !`7�?�l � ..... ................... at ;,7;North Andover, Mass. pi -i- -� i .ir Nn rr� Check #�J 4675 .......................... GASINSPECTOR MASS APPROVAL # MASSACHUSETTS UNIFORM APPLICATION FO (Prinntfor Type)_ ^ J' .. J�/ - J' �'��✓ . Mass. Date )zia Building Ie G New 0 Effifflirrman Renovation Q. P GASFITTING Plans Submitted: Yap No Qg Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET 2 Corporation 103C MIDDLETON, MA 01949 r . Partnership Business Telephone 978-774'2760 [ Fm- 1Co. Name of Licensed Plumber or Gas Fitter WILLIAM R. •HARR T S INSURANCE COVERAGE: have a current liability Insurance policy or its substantial equivalent whic'; the requirements of MGL Ch. 142. Yes M No O If you have checked YL, please Indicate the type coverage by checking the a;propfiate box A liability Insurance policy 13 Other type of indemnity 0 Bond G OWNER'S INSURANCE WAIVER: I am aware that the licensee does nct hav► the Insurance coverage required by Chapter 142 of the Mass. General laws. and that my signature on this permit application waives this requirement. Check one: (, wrler-D Agent 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in atx+e appkaticn at true a accurate a bexe of my knowledge and that all plumbing work and installations performed under the permit' for this p is all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Lrr+s gy T of License: I lumber gnature cf tuber ar mer Title Gurn asfitter Master License Nbe 3785 City/Town Journeyman ( NL n Y Z C in y Q H ¢ O z n S !- ry b W ,& ¢ O rl m f = n C i m <} z z o r ¢ a a m W Ir -y W= azi z 0; 1 d o C< % W W yCj A j <_ ¢ Q p C W ~ Q> W V b C J 1- Z F. b Om Z O ~ W O M Z . ¢ •= O tl Z 4. D p J V C> Q 6 H O SUB—BSMT. BASEMENT I IST FLOOR I I I 2ND FLOOR I I I 3RD FLOOR I I I 4TH FLOOR I STH FLOOR ( I 6TH FLOOR I I 7TH FLOOR { I 8TH FLOOR tul I( I I Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET 2 Corporation 103C MIDDLETON, MA 01949 r . Partnership Business Telephone 978-774'2760 [ Fm- 1Co. Name of Licensed Plumber or Gas Fitter WILLIAM R. •HARR T S INSURANCE COVERAGE: have a current liability Insurance policy or its substantial equivalent whic'; the requirements of MGL Ch. 142. Yes M No O If you have checked YL, please Indicate the type coverage by checking the a;propfiate box A liability Insurance policy 13 Other type of indemnity 0 Bond G OWNER'S INSURANCE WAIVER: I am aware that the licensee does nct hav► the Insurance coverage required by Chapter 142 of the Mass. General laws. and that my signature on this permit application waives this requirement. Check one: (, wrler-D Agent 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in atx+e appkaticn at true a accurate a bexe of my knowledge and that all plumbing work and installations performed under the permit' for this p is all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Lrr+s gy T of License: I lumber gnature cf tuber ar mer Title Gurn asfitter Master License Nbe 3785 City/Town Journeyman ( NL t Date .... �!..���� ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING / S ' Thiscertifies that..(...........,.......,.,...................;............................................... has permission to perform �c...............:,mss!7. � . ....................... J ` wiring in the building of 77� at ....................................... .....................y ................ ,North Andover, Mass. ,p. Fee �.or....... Lic. No . ........ .................................... ELECTRICALINSPECTOR Check # 5394 THE COMMONWEALTH OFMASSACHUSE77S Office Use only DEPARTA1EW0FP. BUCSAFETY Permit No. 3 �� BOARDOFFR EP NREGULAT70NSR70,fi?121X1 Occupancy 8t Fees Checked APPLICATTONFOR P O PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDA E THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR, TYPE ALL INFORMA4 IVNY Date 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) _770--60 Owner or Tenant Z) Al .lam r— 15 (p, Z % 1-/) o v S Owner's Address 19� j9 --r''1 L Is this permit in conjunction with a building permit: Yes EyNo (Check Appropriate Box) Purpose of Building 01 At Et—i._/ j%JL..- Utility Authorization No. Existing Service AmpsVolts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work A- (% 777 1 U N VV r FZ- 7 rel XC 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 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 JlL /�f"f 0 ksw&= ovw,V. RwuarttDtherel]lIIlOmled.SOf ugetCiernWLam Ihawsuhniwdvafidproofofsmw1D Offs= YES a hox WSURANCE L3--- BOND r7 OTHER a (Please Spec$y) WC&tDSw FMMNAME alert YES " NO ff}ouhavedrekedYES,pleaseirrdr *thetypaof by 4^-, Esbrn&dVaixdE1ecftical Wak $ kEpecttmD*RaVes1vd Rao 6-0— .4/4 F11111 LioarseNo. �^ g 7; A c _v Llcer>see Slgnahue Bt];;Te1Na I 7k 9,45 ' 1 f 3� p (V �rl N At Tei No. -4Q-?, (.i 0) 7 C? OWNER'SINSURANCEWAIVFR;Iamawa da ftLioewdomnothametheir>stua ama?orAsatsarialepvalentasm medbyMassadu�Ceimallaws andel atmysignafteon ftpemritTphcabon waives this mw*ff = (Please check one) Owner Agent a Telephone No. PERMIT FEE $ signature of Owner or Agent Location No. Date rORTN TOWN OF NORTH ANDOVER p�tt�ao •,'�'O ►°3Aars kift Certificate of Occupancy $ 1"J • - Building/Frame Permit Fee $ /4-0 sU ,'t ACNUSEt Foundation Permit Fee s7, Other Permit Fee $ RECEIVED PA��/i onnection Fee $ /,!"), ) A =--- NOV 3Nater Connection Fee $ "'14', TOTAL - $ �} G Andover CoNecto- t e7Building Inspector 5720 Div. Public Works Location No. �% i Date `� - Z. 0 ;�4, TOWN OF NORTH ANDOVER S Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ X:L-, ' Other Permit Fee $ Q60 wConnection Fee $ y' REC 44TIFee $------- Oal)TA9 IN $ No. Andover Coileoto� Building Inspecto r Div. Public Works Location /7 C7 S6 No. Date OfNORT" TOWN OF NORTH ANDOVER t��o •11.Q Certificate of Occupancy $ # Building/Frame n�� Foundation Permit Fee NPA _ s�cMus OV I Other Permit Fee 19`j 2b Sewer Connect' F e $ ,CrO � f ¢ 1 Water Connection • eedove1�ca, TOTAL F 0 J 4 0 a W K 6 U J K 'v �1 0 z W � 4 C 0 o w z J i N U 0 0 _Z ` < 0 W 7 J Q m 3 f� ID z O W ! JF,• ( m m ' r Z w 0 < F < O W �J < K 0 ! i 0 J �} I 4 W z O a a Fv ., i 8 W F W m U. a :! IL WW z Wm U a s O z F;0aoaaaw ' m U U 3 m< C O m m m v O O < M J W 0 W W 9 r N 1R N a ph� W aC W p Z 3 c m Z Q O m J F F x U) 0 0 Z W O y W J y a 0w 4 0 D N L Z y m W N y J m Il O 1 f- W d s' � � b U � J Q N � CL moi° ti Z 0 p v J O J y y y � a (J W E O z O z a � O W < y u. y m m F fti " l? II a < Z U O N \ J z O zo 0` � j F 0 J 4 0 a W K 6 U J K 'v �1 0 z W � 4 C 0 o w z J i N U 0 0 _Z ` < 0 W 7 J Q m 3 f� ID ly . � O W rn O F u Z M y m 0 0 UU W W N y N j •j 4e 0 0 m J_ J_ = 4 4 0 - N m W W W< < y a a 1 C 0 ( U ' W ' a z O o ! JF,• ( m m ' r Z w 0 < F < O 01 �J < K 0 ! i 0 J �} I 4 W z O ' V �n Q Z Fv ., i 8 W F W m U. a :! WW z Wm U a s O z F;0aoaaaw OK F U U 3 m< C O m m m v O O < M J W 0 W W 9 ly . � O W rn O F u Z M y m 0 0 UU W W N y N j •j 4e 0 0 m J_ J_ = 4 4 0 - N m W W W< < y a a 1 C 0 ( U ' W ' a � y ! Z J 0 _Z 0 ! JF,• ( m m ' r Z w 0 < Im i > C .10 IL° 0 N 01 < I 0 i < K 0 ! i 0 J �} I 4 W z O ' V �n m o U. 0 Z < i z < < L0 < 0 to W F W m U. a i A ti N /L D T 0 0 D D O D O,< NN I" n O m m A A" N N < ti D D< O 0 p A 0:c 0 0 zznix-n0�w m m o m D m m= 0 0 p A y rn r = 00 OZ O 0 Z Z 00 O N O 0 y N NO �z_ O S T or Z Z C)Z_Ll N 2 I I\ Z T JODZDDp300 A a n T� z O z z N N 62 S G7 A o 0- N l>lm fo O m O m? A OZ O N xo 0 O N m AX`2ZZ nz A X rn mm mm <� Q, N mOZ , D A O D O,< D 2 y A v y LA Z N O D p 0 0 Cox m m o m D m m= 0 0 p n = O n m m -1 ZD DTzNc20 _2N_n mao �z_ O DO rvrAZ �0`- _C m �- 0 F O O 0 0 2 3 T O A n A ti A w m O A 70 m r z 0 xo 0 O Z AX`2ZZ nz ON X a mm mm <� Q, r 3 T > y 1 1 c A 0" m f T c 3� m A T Z y I I�m0 T N X 00 A N210 9_ I I I Z lI illlll�!III O � IllilllW �00 I I 1111 mOZ , D A W moron A N >3N c LA Z . >o m D Cox N u n n �X D n O, No* MRm m m -1 ZD _2N_n mao �z_ O MOE rvrAZ ^ _C NCN �- 0 F 3 Z y w m O c 70 m n 3 - 3 - xo 0 O T 0 -1 7v nz z�c a mm mm <� >O r 3 1 1 N f Z y Z lI O � � �00 � 1111 Icl _ �" Oo m Z Z COv2 Z{ T y v� D Zi ODC ON T O > y o m n n A Z Z D� n 3 n D A O 2 O N N 0 � C) DA y m Z D z D IIIIIIN il�ll IIIII" >02 C).1N N 00-0 • Zm nMO . >o NZZ Cox c N �X D n 010 No* MRm -1 ZD _2N_n mao �z_ MOE rvrAZ DAN mWO _C NCN �- 0 F 0�0 Z 1G)r r�N0 >*> 70 m Z�Z A xo 0 O T 0 -1 7v nz 10 mm mm >O r 3 1 1 f 3786• x 65- 246090- 247- 5•246090• 247• x 6.5 x 1605.5 � 4 Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE—Z 0 JOB LOCATION_*-? 7 0 Number Street Address "HOMEOWNER" n Uj C / h Name Home Phone PRESENT MAILING ADDRESS 7 G 7T lit/ Section of town ork Phone � a I . /1 , City Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwell- ing, attached or detached structures accessory to such use aid/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of ,North Andover Building Department minimum inspection procedures and ..requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE.e KV�J�A .APPROVAL OF BUILDING Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. OCT - 5 l992 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary , approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicantfills out this section***************** APPLICANT: Rall a t-/) (/lJ-G 1A Phone 6f r 6 �L-1 LOCATION: Assessor's Map Number %0 4- jQ Parcel /12. Subdivision —koj a Lot (s) 2 Z Street O cs T 01 St. Number ************************Official Use Only************************ RECOZ51ENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Health Agent Comments -T trW 5&&),6X1 Public Works Date Approved Date Rejected Date Approved l b Date Rejected Rejected Date Approved Date Rejected sewer/water connections < c/ /73Sa 261100141, / r31<c, driveway permit ,� � cLZ-4, fes,, mat cat cpn sir F// Z Fire Department . 031;r-� Received by Building Inspector OQ z F N N: v� uu y _ N: h 'U a a•O a O W Z v •ri: A p Z N: a: V : U: - tn: F K cd0: CaiO O C4 ° f a 'C7 j wbio > h v Wp Nw:: O:M ro: N: U 0 a O: ,° oZ .0 ° 4. 3 w a: v: ro: • �: j ro: aj: �: w" v J rx' Z O: w; Cd a d: a 7iro: tn: yo AmN:�: RC N:y: U : to {OwJj.: U?Ss H: >; :: >` = 1: U: zQ Owto QN F °It b N: to ab 7 O:a: v : d FJ N° 'o O' O F": Ev'O p ro� X;>ux', nO �f; OJ: `,0: OW0. M: O pi* O O O cd a' m M It y N : % cd u ¢ cd dd I- N: vl : v: u a 31Y W y = p a : w? a a1 z v: N: q �, z r♦� rn tr w a: �1: Ai := 9.13 G d o U u u N: o Eos' u. i„ 3~ to Ez +ME U' 44: :: r•1 : : o o z vi ,;4:: 0: a U zi LL z; Z: p �z0 o1 , :o - -UnWz ro•S J bbd -49 D. z O: a: a) N: :i : ci 41 rAE a: o: a14 o v td: m: :z •° w o ru ro ytEo Q9 +iS a lt=!' LLvi a Fr O va.r :: 0: a4) O d Ako:a : o :w 5 dNi WN D. O J N roO .0 41° 0° CaOJ rd 49 In a a 1u Cd O te- r, W •U (� N rn ON r -I \r W 10 :o •Uro to 41 m o E N tr a .a•+ ur°+m Ua C7> v o NAu �twiJ AUG11 PII '9Z 3 26tw a 4J N •\ I NUS E two U .� � 4 m w 0 WlN NW4J w UA • o a ro •r, Nwo,a w N O w m w N o O O aM0 wo M M 44 4J aa) 0 -1 -1 N a) opo to z U. A J:7 m a m N N •r1•rl w .0 O E -t to •r1 M m JJ ,-i ab3>, +1 H J-1 w to to m r-1 W W JJ w a U w Ham w ta m o mb° b N uxR1 N A a N o•.1 o a w w w a to w a N• N N a •r1 ra rt s p, O Nm r1 N -too w>14 04104 ra w • a. ro E .. to 1 to w z 0 JJ w A U a r -t a > o P 0 -4 m N w O p r1 u ri m m o O w •r1 Cw J•1 .a to N a ro U.0 V a) w 4wUa00 � a .0 UNNNm N 4J 44JR7 W 4 w o w N m .0 a .a ra a) .q •r1 a .tJ w a o w O a tn w U :j ro to M m•r11J a ro w 3 H N m w N m .r.1 UV NO w41 tT w .0w No V ro w %J•q ,q m w 04 w N -A a w .►J a) r-1 a m a w 030 •� -40 ZWWJ.1m hwa)w .+ -U row ro o H M.O W N� w m •.� 103 w w M O rA a atn 4-4 ,ra a UM w w >rtn3M p, 14 a ro rooww a) 4J Oro r-1 0 to mw U N a) U dC 1n r 1 V N m .11 41 •r1 d a) >, U N V. J.''. w � m rAM rd 00.410W 0V 00 rood .u0 A M am a L � d Nriro A > w w A w•r1 wM A Mor•+° tT o>qw as •a Na r1 a w m•rlopGt a>. UOwOW ow w oaN wm [ to 4V Ua00 UHtVO .crow dw w r1 ro' A m> V 4J w 3 a o a N= O N N U w :N m M N m >r m .0 • V M •rt 1J U 0 rt w r1 -0 ti r4 O w 10w N 1J rq w U w N v w a w N H • A N to � H U M N • •d J-1 M 14 W N J.) E w 0 N w w w Ww V 0 W ra a M •r1 m, M •r -,•r1 m a E w a a NaM w� V0M-1 EN�•r♦ JaEw Ow q r1 a) 4O N •• r4 a to w a N to O w U V w W AG U w` 3:4 NM w t - N w w M NN Nw v •• N F, U a to o' w N o co a a s >ta a.0 yJ w w w v r-1 a to to q q V W > N m •,A m N 4J O w +1 a •• E V H >1 M >r % o ra ra N r-1 Z r, ro m � Z MAN N ro a m V .04 .{J a M w w m z H tpl a) a) q! taw amaU w ro0 E+1m MNO •d a w 2 T i (-1 v 4. r-1 O >7•r1 v v •r1 a v 4 4 v a 0 v -% z> a •r1 r -A w wqw w .>~ V w w w w 0 •r-1 U ra O >.•a qr s �O .a m t-3 o+JmwN •r+Em td m m 04JV ma04p zro W 1J (a w wa •r1 ro w m 044••rtm a) 44 wwo w w NOM N ao W o a ro o o •A r+ U w M U m w ... . 0 M O AMo Umt O U.a z 0 N N •uMa •r1 +1NMV � a al V. mm•rt ar+>.'. m 1 m ... .t 33I. '� 3' N 0-4 O +1 a N a •r+ w w a) w w r >, >t m w w t�:sr odor r9£.: >1 w No U i z w •r1 N H > a) O 4-1 O a) N a) � • a) O m ':.,. i•�ro a) • w H O NA aMU4 > w w > >, ... tn o U t U ro z 0 o w N w w m o q a o� w 9� to 4J m w a'[•1 wr-+ 1 Ua m1.aN •O H00Z Uvm Uror4 +J 9 V U xvi H a 43 H •rt r•1 w %D Z tT N Z E a •r1 m a to m H M no v a to E— a w a) N M41 a) U ; M >4 q Oro N m >,m •ri m a 0 r1 M> rq a 3 a) H to .-t 0 a) t, a a) 4 A r-1 >r N o >r 4 m 0 .a m a Waw a„ w Ha aJ M •raV%D HNU H.u° •r1 Nro a0 .[ m 3= >r a aN 0 to > > •r+ (0N 4-) U 0 r4 O w > o r ,-1 aq A �.'W ah 3ra wHhU UAUr•1 m 1d tnU N rn ON r -I \r W 10 :o •Uro to 41 m o E N tr a .a•+ ur°+m Ua C7> v o NAu �twiJ bow a 4J N •\ I NUS E two U AwAw zoz m w 0 WlN NW4J w UA o a ro •r, Nwo,a w N O w m w N o a)0wU aM0 M M 44 4J aa) 0 H � w •� m gror-I a m N N wLro N waNA ab3>, °a a n N NACU Ham w ta 4Jrow --rc.r/o ce 10-7 rr'YdOv divld w I C 3 0 FE4 LN � 771 WA - C E � cr z W ui s-� .Q of � � 0 .� a 4 L 0 c oc WW W W c Q W) C %A Z H z .— d z M z R W MA o O z •C V R h z d W b4 IQ p C •_ z v � �- oc m O Z �, �6 m m L C L LU L V t m Y O L C O C W O C 0 C 3 C m ca OC U ii a: U- Q to U. Q ii m C E � cr z W ui s-� .Q � � a O .� a 4 L C R c � V E c o. OC C Z � .— O M R �C cc N •C R V, d b4 IQ •_ Q C •_ � �- .J O Z �, 0 L w O z 4 i y rr z W Q G LU am E a � =z s H >° w o r �x � w d �i OD c c 7 00 L L1 � 0 .9 OR NOR L i[ 0 CL W� to �3 .� a CL i �\ 7 L C 0 a`�o `t W o' � C o' t(C z E � ¢ U ii `�J V� U -Q m to LU am E a � =z s H >° w o r �x � w d �i OD c c 7 00 L L1 � 0 .9 OR NOR L i[ 0 .� a CL i 4 a -fl � c C v O d u a, c a O c z D C •. C. O 3 C 0 O o0 V 0 M T� m T f� .0 w CL to ._ c 0 � r=.r Z� r 14 72 abc a� c c u o u C C 0 L q U E C •+tU—�+ ` .t E t07E s C V O pmp Na' td ~�`v•cn �> cy =.O3cm 2E'o.'ovo ozo 0-4 C+ O OC, CL V) 0 cN_c coCmC cO In SO 10- pccc m�q Fd UID 4 _ �O•��v0 �Jj v -cam ;o - S 7.v �oo u a 1-4 0 c 4):% `E�coicvQE p, y,0 E Ix LU ov�Ev E�vcc y•o EC•OZ c Cic o�oCL -ECVO c "c L�- c 0. o oi �N O o�o oEco c y O c c U -0 cO € 0 j m C739 N + v m� ; E U,cv—01 E v Z c=Eoo w cc q v N Op UG r_ LU NG U L- iLO 0 WM Cr— i dd oO _:S N O M ®O ❑ 'CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 474 (1992) Date JULY 2, 1993 THIS CERTIFIES THAT THE BUILDING LOCATED ON _ 770 South Bradford Street (Lot #22) MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 -CAR GARAGE IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Ronald Cuscia 17 Alcott Way ADDRESS North Andover, MA Building Inspector 3.769 Date ...... � TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... ......... .............................. has permission to perform ........... C2..... ...................................... wiring in the building of ..... ................................................... Andover,M -tat ... 770 ...... -,.u... .. .. .. ....... .... hM ...... ......... ..... . .. ort Fee ... 7d.:.JV.. Lic. No. .............. ..... . . ..... E [CAL INSIfECTOR Check # -5 — 6 �- e�-- Official Use Only c Permit No. Vr wrt oa %g#w Sako 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 I td 1 0-L_._ To the Inspector of wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Nu— � mber 7 b S 2 � Owner or Tenant I K0 M A—, +�P ` t 7ZD Owner's Address '� Alt E Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building �%� ��"� Jk'C_ Utility Authorization No. Existing Service O Amps 1 -L, -LKz) Voits Overhead ❑ Undgmd No. of Meters NewlService Amps Volts Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Locat>jon and Nature of Proposed Electrical Work i N AvbzJ e- U 6 1071 S�6 Patic'�- INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including®;�pleted Operations Coverage or its substantial equivalent Q NO = have sutittt d valid proof of same to the Office�S T NO = if you have checked YES please indicate the type of coverage by checking the appropriate box I SURANC,V= BOND = OTHER =. (Please Specify) (Expiration Date) Estimated Value ofI ncal Work$ �n Work to Start S�Cy 1 - —T Inspection Date Resquested Rough Final Signed under'tPenalties of perjury: FIRMNAME k� �Ly' i�C (ik- S�N CSI CES �r -� ---- t --n LIC. NO,.M OWNER'S INSUR44,CE WAIVER: 1 am aware that the Licenses does not ha' General Laws. And that my signature on this permit application waives this (Signature of Owner or Agent) NO. -I' Z:? 9 Bus. Tel No. 66;� 3 tom-' Zu`l'u Alt Tel. No. .the insurance coverage or its substantial equivalent as required by Massachusetts cw1rement. Owner Agent (Please Check one) Telephone No. PERMtTfEE - Total No. of Lighting Outlets Lt No. of Hot fuse No. of Transformers INA Above ❑ In ❑ No. of Lighting Fixtures to Swimming Pool grnd ❑ grnd ❑ Generators INA 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 Cord Tons Initiating Devices No. of Sounding Devices No./ of Self Contained N?.: of Di sal Heat Total Total No. Pumps Tons KW of Dishwashers Space/Area Heating KW Detection/SoundingDevices ❑ Municipal ❑ Other Local Connection -'91 N1 of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hvdro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including®;�pleted Operations Coverage or its substantial equivalent Q NO = have sutittt d valid proof of same to the Office�S T NO = if you have checked YES please indicate the type of coverage by checking the appropriate box I SURANC,V= BOND = OTHER =. (Please Specify) (Expiration Date) Estimated Value ofI ncal Work$ �n Work to Start S�Cy 1 - —T Inspection Date Resquested Rough Final Signed under'tPenalties of perjury: FIRMNAME k� �Ly' i�C (ik- S�N CSI CES �r -� ---- t --n LIC. NO,.M OWNER'S INSUR44,CE WAIVER: 1 am aware that the Licenses does not ha' General Laws. And that my signature on this permit application waives this (Signature of Owner or Agent) NO. -I' Z:? 9 Bus. Tel No. 66;� 3 tom-' Zu`l'u Alt Tel. No. .the insurance coverage or its substantial equivalent as required by Massachusetts cw1rement. Owner Agent (Please Check one) Telephone No. PERMtTfEE C C Commonwealth of MassachusettsFil OfEcial Use only Dop�artment of Fire Servicesd Fee Checked BOARD OF FIRE PREVENTION REGULATIONS cave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be'performe-I in accordance with the Massachusetts Electrical Codet�(MEC), 527 CMF 12.00 (P1 F,_,4SE PRINT I�'W_K OF, E 4 tL t��OVMTION)i Date:City or Town of: By; his application the undersigned gives notice of his o her intent -ion to o e the tr cal q k described below. ]Location (Stye t & xi '� ^ p e um er) Caw ier or Tenant Ow ier's Address , Is tlris permit in eon}u-iction with a buiEding periiiit? l'ur>ose of Building EAsdii Se • l7U Telephone Yes [,: No ❑ (Check, Utility Authorization No. riate Box) El ,rice Amps l��1�O 'Volts Overhead ET Undgrd ❑ No. oi'11leters Netii Service Amps Volts ,-_Overhead ❑_. ,t7ndgrd ❑'I©.�of;iVIeters Nun;ber,of 1 -ceders and Ampacity, Loc:ition and Nature of Proposed Elect. ical Work: No. No. No. No. No. Completion of the following table may be waived by rhe Yn.cnnrrn. �f m; ecesse Fixtures iso. of Ceil.-Susp. (Paddle) Fans rt N GJ. o. of otaI j 0f Lighting Outlets No. of Hot Tubs Transformers KVA —I Generators KVA of Lighting Fixtures ;;wimining pool above ❑ - [f'No.-Ofmergency ig ang >rrnd, rnd. Batte Units of Receptacle Outlets l � i�To. of Oil Burners FIRE ALARMS No. of Zones of Switches No. of Gas Burners I. o:etrec on an of Ranges �I lo. of Air Cond: Tons Initiating Devices _ No. ofleng Devicesof Waste Disposers Beat Pump umber Tons KW Totals: ' o- o -contained � Detection/Alertin Devices ADishwvashers --- '.pace/AreaHeatin KW ? g unci a Local ❑ Connec ,on Other ADryers . heating Appliances KW — ecurity ystems: No. of Devices if water Heaters K�`°' i•.o, °' ° or E uivalent Data Wiring: Signs Ballasts No. of Devices or Equivalent hydromassage Bathtubs Yo. of Nlotors Total ITP Telecommunications tying: -'- — — -- No. of Devices or E uivalenf OTI tER:: S V Attach additlonaI detail if desired, or as required by the Inspector of wires. DISI' RANCE COVERAGE: Unless wai ,ed by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insui ance including "completed operation" coverage or its substantial equivalent, The under ogyncd certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office: CHECK ONE: INSURANCE Ly- BONT ❑ OTHBR ❑ (Specify:) i stint itc;d Value of Electrical Work (Expiration Date) �DQ ___ _ (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion, l Gerd 51, under the a' -and penalties off eijury, that the information on this application is true and complete. FIJI -1 NAM A fAt t u _ ry: l'.Q9� LIC. NO.: 01017 $Z. Signature.--� LIC. NO.: Cbvu .Tf app, icable, enter "exemp " in the 'icense num her 1 Addrtss: \O CA°) t,� `u��� Bus. Tel. No. -1 "i�bci-3'�g� O WN EJR'a INSURANCE WAIVER. I a, t aware that -t e�Licen§ee does not have the liability insurance coveragnormally �� requirod by law. By my signature below, I l.ereby waive this requirement. I am the (check one ❑ owner Owne -/Agent ❑ owner's agent. >ignaiure Telephone No. PE1ZWT FEE. $ I 96 Lr) li r.v*L _ o k 3_ zy- o s � 1 I/D