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HomeMy WebLinkAboutMiscellaneous - 80 NUTMEG LANE 4/30/2018a Crawford & Company 1001 Summit Blvd Atlanta, GA 30319 Phone 877-346-0300 Re: 4/16/2015 Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 Insured: Claim Number: Policy Number: Our File: Date of Loss: Type of Loss: Location of Loss To Whom It May Concern: BRODERICK 70HN1_CHAPTER 139—LEI 1ER_CRAW.PDF John Broderick 033569669 20563400005 6776-2593765 2/26/2015 Ice Damming 80 Nutmeg lane North Andover, MA 01845 A claim has been made through Arbella Mutual Insurance Company which involves loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Very truly yours, James Warren Crawford & Company CC: City/Town Fire Dept, City/Town Health Dept Date . �... ' 12/0........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING r This certifies that `� -- �� u . _....................................................................... has permission to perform :...... r.:.T.:..=- wiring in the building of . ................................... at .. �..... �12��- -L�'! ..rt. u .....................(... , orth Andover, Mass. . .................... . Fee :...vim.! ............. Lic. Nod :. 2 , ......................�'-' EtEA11cAL I Check # X6 8 72- 1 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the "-permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. - Permits shallbe limited as to the time of ongoing construction activity, and maybe_deemed.by theJnspector--of-Wires abandoned.and_invalid-ifbe—. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. D,,�The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiation date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending"through August 15, 2012. 8 — Permit/Date Closed: _ 3 *** Note: Reapply for new Extension Act—Permit/Date CIosed: /,� _141 14 Commonwealth of Massachusetts Department of Fire Services UIV BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. p7P-/ Occupancy and Fee Checked — ;ev. 1/07] tleavP t,t�"U� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrica�W* ode7 CMR 12.00 (PLEASE PRINT flV XK OR TYPE ALL INFORMATION) Date:0 City or Town of: NORTH ANDOVER To the InspWires: By this application the undersigned Ives notice of his or her intention to perform the electrical work described below. Location (Street & Number) HO /1 -1 - Owner „1„ Owner or Tenant Mct,rIx C ^V\61 � Telephone No. Owner's Address n oil. ,.,, o ti n Is this permit in conjunction with a building permit? Yes Purpose of Building -i hi S auc�-V\ Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and.Ampacity No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: f7 e, Gr- 5-yLA)l C"M Estimated Value of lec al Work: (� d O q -""'a, or as required by the Inspector of Wires. t (When required by municipal policy..) Work to Start: a. I d- Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE OVERAGE: Unless waived by the owner, no permit for the performance. of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation” coverage or its substantial equivalent. The undersigned certifies that such cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of erjury, that the information on this application is true and complete. FIRM NAME: SeDn (� j�s ger r LIC. NO.: 3L 8 Licensee: SQq n P\kkol� Signature LIC. NO.: (If applicable, enter "exempt " in the license number line.) Address: CQ&- M, sc, (Q �� Bus. Tel. No.:�'-(ZA "� �q11 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner F-1 owner's agent Owner/Agent Signature Telephone No. PERMIT FEE. $ k, jr #f ! >a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 *ashinb ton Street Boston, MA 02111 r i www_massgov/dia . Workers' Compensation Insurance Affidavit: Builders/ContractorsXlectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgmiza6on/Individual):__-C Address: City/State/Zip:'SQ to 1 r TM Q 0(9f�6 Phone Are you an employer? Check the appropriate box: 1. ElI am a employer with 4. ❑ I am a genera[ contractor and I Type of project (required): Q'mployees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction . 2. Erl am.a.sole proprietor or partner- listed on the attached sheet $ 7. ❑ Remodeling ship and have no employees These sub -contractors have S. Q Demolition working for me .in any capacity, [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its g (� Building addition required.] 3. ❑ 1 am a homeowner doing officers have exercised their ��,�; 10.2 f teCtrical repairs or additions all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No•workers' comp, C. 152, § I(4), and we have no 12.0 Roof repairs insurance required.] t .employees. [No workers' 13•❑.Other comp. insurance required.] t r..— ..• �w. M . ��x rr must aiso nn out the-sectton below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they arm daring all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must a.7ee.� an additiohal sheet showing tete name of the sub -contractors and their worker=' comp. po!icy !nfamradon. I am an employer that is providtng workers' compensation insurancefor or my employees. Below ;S,the information. policy mtdyob site Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date), . Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to $4500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebycerfify under the pains and penalties of perjur�J that the information provided abpve is true c59 CT Official use only. Do not write in this area, to be completed by city or town ocia[ 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 M Contact Person: Phone #: �r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. 1 Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, - �J express or implied, oral or written." An employer is defined as "an individual,, partnership, association, corporation or other legal entity, or any two or more of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. *However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation• affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cant' 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 Ese sure to sign and date the affidavit The affidavit should be returned to the city or town that the .application for the permit or license is being requested, notthe Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' 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 Officisis 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 permittlicense number which will be used as a reference number. in addition, an applicant that must submit multiple permitAicense applications in any given year, need only submit one affidavit indicating -current policy information (if necessary) and under ".lob Site Address" the applicant should write "all locations in (city or town)." A copy ofthe 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 fitted 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 TeL # 617-727-4900 Ext 406 or I-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia v Date .... .Cl...! . ................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . e-'= . �^ `�' ........................................................... .............. has permission to perform ,`.��c( ......�? 'r.Je...!.�-............ wiring in the building of......-! +. V. ' �' �4— ............................................................................. c -oat ............. ..............!!� t.....�..................North Andover, Mass:' Fee .............."...... Lic. No. �.... ! t'.�........... ............... !? ,f /ELECTRICAL INsrtdOR Check # e -) r r I i C �(� t,ommonwea& o/ MaMachaaelb Official Use Only cc� Permit No. 2iepartment of5 ire Service9 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL VVORK All work to be performed in accordance with the Massachusetts Electrical Cod (MEC 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date4AI M 13 City or Town of: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant h Telephone No 7$ 8 -61 Je� Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Pox) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts ov-,rhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: CX1 �SA S rn c=' Com letion of the following table inay be waived by the Ins ector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Padd.16) Fans TransTotal Trsformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above In-' ❑ rad; rad. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Rapges No. of Air.Cond. o ns Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons KW No. of Self -Contained . . Detection/Alerting Devices No. of Dishwashers Space/Area Heating K\Y Local ❑ Municipal ❑ Other Connection No. of Dryers Y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KWSi No. of No.. of a"Ilasts ns -. Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total I -IP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the hrspeclor of Wires. Estimated Value of Electrical Work: 0(In (When required by municipal policy.) Work to Starts J Inspections to be requested in acpordance 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 cover e is in force, affil has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE V BOND ❑ OTHER ❑ (Specify:) 1 certify, under the ains and a tallies of perjury, -that the irrJprirfatiou on this application is true and complete. FIRM NAME: inc s' LIC. NO.: Licensee: ,� I' - ' v Signature O.. � (If applicabl e, "ex mp " in the licens nuj ihe�i e.j L /� Bus. Tel. No Address: I 1 Alt. Tel. No.: ti —�— *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. > Ti 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 Sign,%ture Telephone No. EPE"IT FEE; $L4 SCS No -c'3 �� M4L c Please send all permlts, permit permit/L nsee Qe prtrpent 5S Seb.ethjq Drive Cromwell4T. 06416 Attn: Carmen Mercadq if.you have any questions or Foncerps Itlease feel free to captp[t me at: cmercado@safehomesecurityinc.com �-800-$33-3211 a t:1 Q Please send us our customers permit umbers so iys can Pi Ryloe them to our monitoring station, please and thank you very much. Thank. you, Carmen M. Mercado 1p r dMMONWEA�:TH O MASSi?► HUS�T� . . •PolgAiMflo oru 111 I+ -M l C1 ANS x ISSUES THE{FOLLOWING LICENSE AS A REO STERIEO SYS7Eh} C0N7RACT01 L � SAFE HOME :'SECURITY INCPtr, i5 AV I f7' R1MAfi s .:1. —� 55 r 7 ;�1��3FiW)rLL fT 06416 10�# SSCO-001.263 DAVID(; ROMAN' 55 SEBETHE DR #201 ° ,« CROMWELLCT 06416 1210312014 0 It N2 3 3 OU Date .... ...... / ........ .... ..... .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................... ; ................................................................. has permission to perform............... ............................................................. wiring in the building of .......... .......................................................................... at ..... ............ ............................. ,North Andover, Mass. ..... ..... Lic. No . ................................ ELECTRICA*'L* CO**T''* R** Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TIM00MMONWE40HOFARMCHUSE77S Office Use only DEPARTNLENTOMBLICS4FM Permit No. c33 6 BOARD OFMEPREYEMONREGMTIOKSS270M IZO • ri✓� � Occupancy &Fees Checked APPUCATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL. INFORMATION) Datg_Z_ 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) /V v7 Owner or Tenant S /%!3 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 Underground No. of Meters New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work4L e-ez Aa>" a ✓ �"� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground 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 13 Connections a No. of Water Heaters KW No. of No. of 'I Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP la r 0 /al,( -4 ir&=XeCaaagz R RMr tbihetegtatana1iSBWsG=2WLaws Iha%eaamatI.iabtld hurm=Pd yixkd gCm lets Cae'ageoritsstst3MeWivaiat YES r_p7.,T NO Iha%emhruWdvaMproofofsmmt3theOlfioeYES a Ifywha%edla WYES�pimeirdc*ftypecfwmaWbydiedmgthe tZURANCE ©' BOND r7 OTHER MEVintim (PleaseSpeafy) pD& ��?aicbsuet / — / �-- O E VakxdE ]chiral Wade S 9 O O , O C/ IitspedmD*Regxstcd Rc%h Final FIRMNAME 112 Signalre ars -e 4� Z-4 wV%�Oh C..e L;t>tseNa g Y S C- S / BusirimTel.N ?.79—/ 9-7-4 AlTeLNa OWNER'S IIVSURANCE WAVER; Laws aodfiratmysign�taeon�p�appfi�arwai�sdlisret�¢ar�i. , (Please check one) Owner Agent , �, / �'—'+ Telephone No. PERMIT FEE $ S Date........ '•••:•• N° 3 .- u 4 i �aoR M o'<«•° ;•'"o TOWN OF NORTH ANDOVER to PERMIT FOR WIRING This certifies that i.-. G c..11.'. `�. �'.. t . ................................................. ................ has permission to perform........ ......! �`�� .............................. ..... wiring in the building ofA• �•E.Lt..... S� ............ .................... r L L • T *. ,North Andover, Mass •Fee "' 1 ELECTRICAL INSPECTOR Check # ?• 2 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �"" Carwnonwea o� %�ad9acltulo� (Rev. 11/99) For Office Use Only cc /�� cc77 Permit Number: 1Jtpabnsal o`.}ir� �iiwiud Occupancy & Fee BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00) 2 PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: R— 3o D City or Town of: ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location: (Street & Number) LG k Cl/ 1 �0U Owner or Tenant: ►'` 410--t- it 56_�� Owner's Address: �/L C tt 2 J_' ) Ali Is this permit in conjunction with a`IBuildiing Permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building: Si t.�,lst. I G N C. Utility Authorization #: U�3 5Z3 Existing Service: Amps / Volts Overhead 0 Underground.0 # of Meters l New Service: Amps 2_0/ ,2-qVolts Overhead ❑ Undergrount # of Meters: I Number of Feeders and Ampacity: � I Location and Nature of Proposed Electrical Work: No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Transformers Total KVA No. Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool: Above ground ❑ In Ground ❑ # of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners Fire Alarms # of Zones # of Detection & Initiating Devices # of Sounding Devices: # of Self Contained Detection/Sounding Devices Local ❑ Municipal Connection ❑ Other ❑ No. of Switches No. of Gas Burners No. of Ranges No. of Air Conditioners TOTAL TONS: No. of Waste Disposals Heat Pump Totals: Number: TONS: KW: Security Systems: No. of Devices or Equivalent No. of Dishwashers Space /Area Heating: KW Data Wiring, No. of Devices or Equivalent: No. of Dryers Heating Appliances KW Telecommunications Wiring: No of Devices or Equivalent: No. of Water Heaters KW No. of Signs: # of Ballasts: OTHER; # of Hydro Massage Tubs No. of Motors Total HP 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 (iC]\ BOND ❑ OTHER ❑ Please specify: Estimated Value of Electrical Work $ (When required by municipal policy) Work to Start: -9-01 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application Is true and complete. Firm Name: I! a-� 1 ct C—te &-" C --A-( LIC. # s Licensee:.�iLrlS'/ Q�ln�2C t��'Cl'i a Signature: �r+ LIC. # / / 14 (If appllcable, enter "exempt" in the 11ense number line) Address: 292. n- p'S6t ] re 144, QiTYG/.�Ailti Bus. Tel. # Alt. Tel. # 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 ❑ OR Agent ❑ Signature of Owner/Agent: Telephone # PERMIT FEE: S Date .................... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation ... :.. �. f in the buildings of ... � �, !�, : , . , , , , �' � ......... . ..... . at ......�... .......................... . North Andover, Mass. r Fee. ! . 7.. Lic. No. J.:. �- '2 Check # 37 OU u GAS INSPECTOR f MASSACHUSETTS UNIFORM APPLICATON FOR PERAW TO DO GAS FITTING (Type or print) to NORTH ANDOVER, MASSACHUSETTS Building Locations /—eqr � /V " ' , ri c6 Permit # 72- 1! kIk z �LAmount $ Owner's Name `� l ��T New Renovation Replacement ❑ Plans Submitted (Print or type) one: Certificate Installing Company Name Com/ / Corp. Address D O Partner. Business Te ephone 1 / `/Firm/Co. Name of Licensed Plumber or Gas Fitter 11�j f ` -/ / i �f/j d /l eey INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [] No If you have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy 13 Other type of indemnity 1:1 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa4usetts State (OFFICE USE ONLY) Chapter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter Plumber 145--2 f� 7 Has Fitter License um er Master Journeyman Date..: f NORTH A } o?°�: TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING f �ss�cwusE� f This certifies that ... + :... .................... has permission to perform .....'.f', .......................... plumbing in the buildings of ...,' ........... North Andover, Mass. Fee.Q: •�!. Lic. No../.". Check # PLYMBING INSPECTOR � I f WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT .TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building tion G47 ( z,',��o NU/A46 ers Name'/ :7— A" of Occupancy -/ 41,1 Date,,< Permit # / L qj Z Amount 7 New 171/ Renovation 1:1 Replacement F1 Plans Submitted Yes 1:1 No 17 (Print or type) Installing Company Name Address h/ �D 7;— -AlCCIT 7 0M P/% /V Check one: 11 Corp. UPartner. Finn/Co. Name of.Licensed Plumber. ��C�JI W)yC061il Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ❑ Liability insurance policy Li Other type of indemnity F-1 Bond Certificate Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Y Signature Owner El Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the M chus g Code and Chapter 142 of the General Laws. By: Signa i e 01 LlCenSeClum er Type of Plumbing License Title 1�Ial 7 City/Town License NUmber Master ' C.{' Journeyman ❑ APPROVED (OFFICE USE ONLY u • a •r ------NOON -------M----..- FRI MWOMMMOMMOMMOOMMONNOMMM iiiiii �• ::� iii�iiiiiiiiiiiiiiii (Print or type) Installing Company Name Address h/ �D 7;— -AlCCIT 7 0M P/% /V Check one: 11 Corp. UPartner. Finn/Co. Name of.Licensed Plumber. ��C�JI W)yC061il Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ❑ Liability insurance policy Li Other type of indemnity F-1 Bond Certificate Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Y Signature Owner El Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the M chus g Code and Chapter 142 of the General Laws. By: Signa i e 01 LlCenSeClum er Type of Plumbing License Title 1�Ial 7 City/Town License NUmber Master ' C.{' Journeyman ❑ APPROVED (OFFICE USE ONLY u Location � � i1/' UJ M'G q ( A ti e - No. I C1 C1 Date j TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ / �) S 6. _ Foundation Permit Fee Other Permit Fee TOTAL Check #� Building Inspector TY) O -Q `l 3-Q00 14ot'S g© PLAN OF LAND /N NO. ANDOVER, MASS. SCALE- 1 ' = 40' ✓UNE 14, 2001 HAVES ENG/NEER/NG, /NC.603 SALEM STREET CML ENGINEERS & WAKEFIELD, MASS. 01880 n�5 LAND SURVEYORS TEL. (781) 246-2800 / CERTIFY THAT THIS FOUNDATION /S LOCATED ON THE GROUND AS SHOWN, AND THAT /T CONFORMS TO THE SETBACK REQUIREMENTS OF THE ZONING BY-LAWS OF THE TOWN OF NORTH ANDOVER. / FURTHER CER7IFY THAT THIS PROPERTY DOES NOT LIE WITHIN A FLOOD HAZARD AREA (ZONE A OR V) AS SHOWN ON FLOOD INSURANCE RATE MAP COMMON/TY PANEL NUMBER 250098 0010 B, ZEjFVEDATE.• ✓UNE 15, 198.EDATE Jv�.1820i"°fM4 VAL LANDS O MIN/MUM SETBACKS- FRONT = .30' SIDE = 20' REAR = 30' \360-¢E' X, Location No. % Date 'A- N5 TOWN OF NORTH ANDOVER Certificate of Occupancy $ 's'••'° • Eta Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Other Permit Fee $ 0 `J TOTAL $ �� T Check # Building Inspector i/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATf OR DEMOLISH A ONE OR TWO FAMILY DWELLING ?a...i%§ a�i'�r4§. 4; '�}` '" fi a5`y� ac . �e '3C V 1 , y� off v, : , .' „✓ s 't . .., w..i s .., .;TX "K .• V P� , BUILDING PERMIT NUMBER: / / DATE ISSUED: Cry � SIGNATURE: Building Commissioner for of Buildings Date 1 SECTION i- SITE INYORMATION 1.1 Property Address: 6 "� 1.2 Assessors Map and Parcel MaprumW Nu ^� 02 / Parcel Number 2.1 Owner ofRecord 1.3 Zoning Information: Zoning District Proposed Use /4 - J (J 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard er o Record: w Rear Yard Required Provide Required Provided Required Provided SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 1.7 Water SupplyM.GLC.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTIUN 2 - PRUPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner ofRecord /4 - J (J Name (Print) Address for Service: t natur % Te9ph o2.2O er o Record: w Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Q1(d 5// Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone I Q SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result 3 in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work checkapplicable) New Construction &. Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: J• i w w Item Estimated Cost (Dollar) to be Completed by permit applicant _} _,. ...� . 1. Building 0 pd -d (a) Building Permit Fee Multiplier / j 0 + Sp p ja b ' 2 Electrical DIMENSIONS OF SILLS (b) Estimated Total Cost of Construction © od C) 3 Plumbing DIMENSIONS OF GIRDERS Permit fee (a) X (b) (� (� -Building 4 Mechanical HVAC SIZE OF FOOTING X X 5 Fire Protection MATERIAL OF CHIMNEY b Total 1+2+3+4+5 IS BUILDING ON SOLID OR FILLED LAND Check Number SECTION 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 j SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 of Date NO. OF STORIES 2 SIZE 4T Q 41 r BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 Q 2 / 3M 73 0V SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS ' DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Y..4 FORM - U LOT RELEASE FORM Lo (�( 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. In one Sam No am a a ifomm" No oil mono a via son now Bona am am Boxes WE news Noon am a am am on an anon am APPLICANT a cz. /l�� PHONE — ' ZS— /7,3 L' q ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION /LOT NUMBER STREET /ta i c G --CL L, STREET NUMBER c� .mons Samoan mono Mon... ..... .......................... . OFFICIAL USE ONLY I■.....■Noon ■■■. noun assume ....on...■■anon Emma *Emmons OEM anon . ass ass .........■ RECONM ENDATIONS OF TOWN AGENTS s■.■.s■.■■......./a.......■■......■.........■............... .■ ........... DATE APPROVED CONJERVATION ADMINISTRATOR DATE REJECTED A /I A TOWN PLANNER COMMENTS Yk-U DATE APPROVED DATE REJECTED \ L 12-101 DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONIIyIENTS �r r► r i , PUBLIC WORKS - SEWER 7 WATER D`�RIV//SWAY PE � 1-0 /2 Gr1 DATE APPROVED FIRE DEPARTMENT DATEREJECTED COMB ENTS RECEIVED BY BUILDING INSPECTOR DATE 4w 1 673 APPLICATION FOR SEWER SERVICE CONNECTION Z' f North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in �V�1/y2 Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No or subdivision lot no. U Owner Address Contractor Address licaks nature /—ki PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works herebv Brants Dermission to to make a connection with the sewer main at i subject to the rules and regulations of the Division of Public Works.. Inspected by Date Street Street D'vis�of Public Works By See back for rules and regulations 1071 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. Application by the undersigned is hereby made -to connect with the town water main in Ai Street, subject to the rules and regulations of the Division of Public.Works. The premises are known as No. Street or subdivision lot no. 7,5 —7,34tY &t"Aled- Owner Address d '� Contractor Address /Xilplicant's Afnature I � PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at. Street subject tc the rules and regulations of the Division of Public. Works. Board of Public Works By Inspected by Date w See back for rules and regulations eIr r Irl 4, i TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J.WILLIAM HMURCIAK, P.E. DIRECTOR ORTF —� DRIVEWAY PERMIT Telephone (978) 685-095Q Fax (978) 688-9573 DATE L"C Y/ Z Oa LOCATION AU I P -c E L'4iU� L" l 4 BUILDER phone OWNER AT 9/, i LL E —7- phone �Z -4.75- 3 4� THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR. APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. X7 A Fr►. cA tIj-F ,s src�*rVA-rveE 4. 1% I DPW 353 Date .... �- —.. -2�- —.. -0. 4 TOWN OF NORTH ANDOVER RECEIPT Thiscertifies that ............. .1............................................................... -+ 2 4-w . 0c) ....................... has paid . .......... .../ ......... *-"*"****"""'* ........... for .... 190"ye, .. ......... /..**-,*,*, —;!!� .................... Received by ........................... ............. 7F Department ........................ .. L, I 0�.; ......... w ........................... WHITE: Applicant CANARY: Department PINK: Treasurer 0 L MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Release 2 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 6-9-2000 or 2 Family, Detached Other- (Non -Electric Resistance) TITLE: ABBOTT VILLAGE SALEM ROAD TYPE L39R PROJECT INFORMATION PAUL ST HILAIRE 96 DASCOMB ROAD ANDOVER MA COMPANY INFORMATION: J&J HEATING & AIR COND 17 ARLINGT- ST DRACUT MA COMPLIANCE: PASSES Required UA = 677 Your Home = 615 Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value --------------------------------------------------------------------------- CEILINGS 1899 30.0 0.0 WALLS: Wood Frame, 16" O.C. 3023 13.0 0.0 2 GLAZING: Windows or Doors 366 0.460 1 GLAZING: Windows or Doors 42 0.490 DOORS 39 0.600 FLOORS: Over Unconditioned Space 1899 19.0 0.0 HVAC EQUIPMENT: Furnace, 52.0 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 requirements of the Massachusetts Energy Code. 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. Builder/Designer Date Massachusetts Energy Code MAScheck Software Version 2.01 Rasa 2_ ABBOTT VILLAGE SALEM -ROAD TYPE L39R DATE: 6-9-2000 Bldg. Dept. Use CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.46 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location 2. U -value: 0.49 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ) Yes [ ] No Comments/Location DOORS: 1. U -value: 0.6 Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT: 1. Furnace, 92.0 AFUE or higher Make and Model Number 2. Air Conditioner, 10.0 SEER AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): HEATING SYSTEMS: Low pressure/temp. Low temperature Steam condensate COOLING SYSTEMS: Chilled water or refrigerant PIPE SIZES TEMP (F) 2" RUNOUTS 0-1" 201-250 1.0 1.5 120-200 0.5 1.0 any 1.0 1.0 40-55 0.5 0.5 below 40 1.0 1.0 CIRCULATING HOT WATER SYSTEMS: (in.) 1.25-2" 2.5-4 1.5 2.0 1.0 1.5 1.5 2.0 0.75 1.0 1.5 1.5 [ ] Insulate circulating hot water pipes to the following levels (in.): I ' PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUT HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+ 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- Building Value Calculation -for Pro a at..... LOT# 4 Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 25 13 325.00 65 $ 21,125.00 Brkfstnook - 65 $ - Dining Room 15 14 210.00 65 $ 13,650.00 Family Room 22 24 528.00 65 $ 34,320.00 Study - 65 $ - Living room 15 14 210.00 65 $ 13,650.00 Garage 24 31 744.00 35 $ 26,040.00 Entry 15 12 180.00 65 $ 11,700.00 2nd floor foyer 14 12 168.00 65 $ 10,920.00 Sunroom - 65 $ - mudroom - 65 $ - Walkin closet - 65 $ - Basement Finished - 65 $ - Deck - 10 $ - Screened Porch - 35 $ - laundry 8 8 64.00 65 $ 4,160.00 Bedroom 1 18 13 234.00 65 $ 15,210.00 Bedroom 2 31 24 744.00 65 $ 48,360.00 Bedroom 3 18 14 252.00 65 $ 16,380.00 Bedroom 4 15 11.5 172.50 65 $ 11,212.50 Bedroom 5 15 11.5 172.50 65 $ 11,212.50 Bathroom 1 8 5 40.00 65 $ 2,600.00 Bathroom 2 17 13 221.00 65 $ 14,365.00 Bathroom 3 9 9 81.00 65 $ 5,265.00 Bathroom 4 - 65 $ - Bathroom 5 - 65 $ F,7' _ $ X70 3 /s ?6) 0 w 0, 5- /34 W/S oa + Ln --i O UI m O � � � a -i m , O Z nom, �, _ �(o _ rn �- .. pe p N —' fD fD m 0 C� �> > �rn O_c 3 cc -� tD p 11O (p O D co 0-0�moa a rn 91M = CD O p p mO (DD O :• In n m toC � d CML ��—, CL a OmLn p 1fD CL a aj CL ,O E P O i m �s a 3 a( Nil, O ° m t fm p v N px a:C D �o:� o Z C� y ti 1 c� CD 70 1 z z o o z Cl) M m C/) 0 m V CA 10 az CD O CL r d � o p CL c� CD 0 CZ O ca CD y CD 0 0 _ CO) C. 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Lx" -Ti i co �W 3 co -3 Oi ha —TI X C. rn TI O • -Ti i �W TI CL A j j -Ti i �W -Ti i r,r o � 3 CD 09 n coN < (D lD Z v a �p o N � d N S p �p o 3 Q (D n O CIL 9' La Is n ,rt - 0 t 0 c� E3 lL' m ('� A h X n cep c X p C r �% -1 N -• r.+ \ \V N lQ 3 tl N W X] it X] 21 O �(P x� �o Xp �3 tpo�no� E E (DQE Q_' a► 0 o Q _Q OroN +_' 0 c 3 Q. 0 In 3 mIn J o 0 � n m 15N 2, w. -2. 111 = r1 X Q0��6 3�OQ0 fD o� Lb. n Occo'' 3(0 � 6N SL (D 0 Q� S m N ( X T X X 0 tp (Sl�Qm•� ��tD� , 7r T U 3 3.n6V EQ-�< N� m (PY�� n 15N 2, w. -2. 111 = r1 X Q0��6 3�OQ0 fD o� Lb. n Occo'' 3(0 � 6N SL (D 0 Q� S m N ( X T X X (Sl�Qm•� ��tD� , 3.n6V EQ-�< N� m (PY�� F. -60 m "' S T_ _ �' s Z_ Z -7 -{ e E (D�� 0c QS 3,.Q<�Q<QQ� Qp,�,• Ow fl- W-3 d'-a-(O�Q �-3. _L 0 0 �, a iw 3 rj' E 3 i tiZj b' (D U' 3 Wi 1-3 E WE (D (D 0 SJ_ -` -'Q 0� W03 IT (old S (D S c • • .+ (D m C) 1b 3 t(b) th N:v 0110 LO�1 W O (D (D 3 (S -•, n' U ' a' 0 • 0wQnn, la p tD 1b l9 3 ' 1113 fP� o,Vn Gn�.N ��< (D(D , (D W fi 0 +r = , U� 'A Q� •• i�� °' 30� °' j LOG ��_ X S 0� -n�� �fl (D�' 6�- (3(5 (D W (L1b'c<<OOlr mom' (D0 _ fpE� _ �f 3 (D t� E 3 W 0_ 0 (D n oil M r3 111"0 Q 1. 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PA iL ro 1rzV 19 P c^n A D ro� + h o Os 3 3 Qf U3 pv t�D V to ? h = , (0 7p 3 D- 3' h 4h- .O O G c 7(1 7U O Q v -P po Oo a to to to N ..• O ro N O O� O (D n N W O c d - -a to1, -+ 0 w to h h o_� (A 0 C w ro c �-p mlb o al ro r -t O � "fes. w VD E� to to to °i D- F 3 --Q to c to N V to mDi to —� .-4 p o v .ar~ 10ro O CP217 Ob ri h 1..0 (D- 1"'1 S N h t--7 to to N l' as n' S 73 to 0 Nd O 0 X � Q. � .� W qui EY Q to d po Oo a to to to N ..• O ro N o a 0 O� iQlCP G o Lnlb n N W O c d - -a to1, -+ 0 w to h h o_� (A 0 C w -7 c �-p mlb o al ro r -t (p 0 --► W p, "fes. w VD E� to to to °i D- F 3 --Q to c to N V to mDi to 3 b o a .ar~ 10ro to 19 Ob ri h 1..0 (D- 1"'1 S N po Oo � NVZ- - N m ro � o a 0 O� iQlCP � (� Q O °i to a lb A O O � t0 ro N -L3 c �-p mlb rn m w VD E� to � Aw F a to mDi 3 E to C to 19 Ob ri h 1..0 (D- 1"'1 S ro n. = t--7 to to N l' r � O 41 � � O � 7U •� acN E ^Z �' � SO c !3 E NVZ- - N m ro � o a 0 C+- ED � (� Q O °i to a lb A O O � S to ,nm c ■ t'�' c �-p mlb VD E� to � Aw F SO � n d d to (1 n � o a 0 -n ro 0 B (P t S1 � (� Q O °i to a lb A O roII �O c �-p mlb O to p N C to mDi 3 E to N to 19 Ob ri h 1..0 (D- 1"'1 S ro n. = t--7 O to N as n' S to 0 U O X � O_ .� W qui (D Q Lek N ILto Do E to 2.. " °i ` I • vT ,DIP 5' QO \ O (D N 0 r�FL Q RL 57 0 iL ro 1rzV 19 SO 0 to d d d N to O to p N C to mDi 3 E 1..0 S as n' S to 0 c+- � O_ .� Fv (D Q O C Do E to 2.. " °i p O vT ,DIP 5' QO Qn O 1 0 2 0 r�FL Q 0 ro 19 0- Os V to ? (0 7p 3 D- h 4h- N 7(1 7U O -P n w m to Q v, tD w ro m O FD CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number / W-1� Date `%`fid `D , THIS CERTIFIES THAT THE BUILDING LOCATED ON 0 0 4 /-/ � 8 G NJ410 p q° 1411) t - MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. q Roorr-) -)']A 66th 13 s+at i `ftZc .o CERTIFICATE ISSUED TO 32 - Building Inspector 4- , �, w\\i \,,_ O z 0 H � c O CL= 'Coo o m o ts •s mac: c a� V: N urn ti •1 yE dw CUR' coN N A _p CO m CD 0 CL m N Q I o` OcCL c W 0 c �+ Aa d= O C z = •- V •O p m 0 .ca C N� a _ ` H � O s $c cc ::w 0 co co .y coL ClC O a� v ev CL H O CL CO) C O O C _cc 0. CO2 0 V O CL CO2 C O OM C O C 0 mm 0 U) Lij Ir w w LLI vJ 0 w w a CO co v b x a\ a O L1 ~ a m � q U w Q+ C O w a w O G O co 0 O z 0 H � c O CL= 'Coo o m o ts •s mac: c a� V: N urn ti •1 yE dw CUR' coN N A _p CO m CD 0 CL m N Q I o` OcCL c W 0 c �+ Aa d= O C z = •- V •O p m 0 .ca C N� a _ ` H � O s $c cc ::w 0 co co .y coL ClC O a� v ev CL H O CL CO) C O O C _cc 0. CO2 0 V O CL CO2 C O OM C O C 0 mm 0 U) Lij Ir w w LLI vJ Town of North Andover a� tAORT}� q Building Department 3? r 6t6 0 27 Charles Street 0 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542�` �" 'F 41 ��SSACNos try APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 9 O LOT DATE REQUEST FILED DATE READY FOR v FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN OFF'S MUST BE COMPLETED WITHIN THIS TIME .. FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES_ SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVATION DATE 7 oZ PLANNINDATE O �- D.P. W. -WATER METE DATE D.P. W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED DATE. SIGNATUR-E7 DPW AUTHORIZATION