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Miscellaneous - 80 WINDKIST FARM ROAD 4/30/2018 (2)
3 i V Date........'............. Co a� Ln l r HORTM TOWN OF NORTH ANDOVER � p`��.ao ,e1tiOp PERMIT FOR GAS INSTALLATION f p g 7 'tis certifies that '.......::.........� ./'./.'�? :� . t......... . As permission for gas installation�.....::....�... in the buildings of ..!.... .:......:...................... at ............................... . North Andover, Mass. Fee........... Lic. No.:......... ........................ GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 461 MASSACHUSETTS UNIFO M A ERMIT TO DO GASFITTING (Print or Type) v � c No . Andayrzt— Pie 'pt# Permit# Building Location 'ft`�CtJi kasAr2raM RLA.Owner'sName 1�i ti�c�rn 1 rt'E �RoY>'%Es lug Map • Lot: Zone: Type of occupancyC New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ Installing Company Name AS6:Irn ]?ro Pant^ +?`y , Lhr- Address 131 Wah r `3i-, _Dcant/s=r`; lrrn►� i 4 3''� EstimateValueof Work: Business Telephone I- Y040 -- Name of Licensed Plumber or Gas Fitter Checkone: Certificate 3 Corporation ❑ Partnership ❑ Firm / Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Ig No ❑ If you have checked y1s, please indicate the type coverage by checking the. appropriate box. A liability insurance policy W Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner (3 Agent❑ Signature of Owner or owners 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen ws. By Type of License: a, :: Plumber Signature of Licensed Plumber or Gas Fitter Title Gasfitter � e / _ Master License Number- City/Town umber `-� City /Town Journeyman APPROVED (OFFICE USE ONLY) �Illlllllllllllllilllllll OEM Installing Company Name AS6:Irn ]?ro Pant^ +?`y , Lhr- Address 131 Wah r `3i-, _Dcant/s=r`; lrrn►� i 4 3''� EstimateValueof Work: Business Telephone I- Y040 -- Name of Licensed Plumber or Gas Fitter Checkone: Certificate 3 Corporation ❑ Partnership ❑ Firm / Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Ig No ❑ If you have checked y1s, please indicate the type coverage by checking the. appropriate box. A liability insurance policy W Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner (3 Agent❑ Signature of Owner or owners 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen ws. By Type of License: a, :: Plumber Signature of Licensed Plumber or Gas Fitter Title Gasfitter � e / _ Master License Number- City/Town umber `-� City /Town Journeyman APPROVED (OFFICE USE ONLY) m a D O m< p, z' m v v D N z � fA e Im O a NORTH ANDOVER BUILDING DEPARTMENT 400 Osgood Street Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: -j� a I, '2- cros NAME: �A ADDRESS: 18 D UJ ► ^,��&+ Fit rPA gJ ZONING DISTRICT: P _ _ 2. TYPE OF BUSINESS: BUILDING LAYOUT PROVIDED: YESNO AVAILABLE PARKING SPACES:' ZONING BY LAW USAGE: YES r' NO ro BUILDING INSPECTOR SIGNATURE Revised 11.5.04 BUSINESS FORM FOR TOWN CLERK 4017 TOWN OF NORTH ANDOVER g A PERMIT FOR PLUMBING g NS!............ CMUSc This certifies that `-��' . �: `� ... , , , , , , , has permission to perform ... !.. ... plumbing in the buildings of .... ...... ......... � at. 0 ..,North A dover, Massg PLUMBING IN�S'P:-EW�Fee�6 . Lic. No��tcc... .�.. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 30 (Print of Type) / , f Itl Mass. Date Z 19_ Permit # '� v� � Buiidln9 Location O ��lzd� ��c.u� Owner's Name � e Type of Occupancy New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES Installing CompanyName �� /� Check one: Certificate Z / Address 7 Z-'�� k N i6f,7 a-3 jQ' Corporation _ ❑ Partnership Business Telephone K G 3 d y3 JS3-;;;t ❑ Firm/Co. Name of Ucensed Plumber e INSURANCE COVERAGE: I have a CuffejRl liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 1No ❑ If you have checked yam, please Indicate the type coverage by checking the appropriate box. A liability insurance policy k Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee docs not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ nature of Owner or I hereby certify that all of the details and information I have submitted (o( entered{ in above appiicabon us true and accurate 10 ttte best of my knowledge and that all Plumbing work and installations perfotmed under the permit issued for this application will W in compliance with all pertinent provisions of ILIA Massachusetts State Plumbing Code ter 142 of the General. Laws. By.� S+pnalure of Ljcdnsodum er Title Type of License: 64asler Journeyman ❑ City/Town 00-7 07 NL License Number z Z N � N Z) O Y Z !•. Z j h W h- W to y J J N t < V < ~ N V W ¢ ¢ V) z N < ¢ ¢ z z O Z a a f - O 0 - N H S N ¢ h' U < W Vl z 2 < C 0 0z t a t 3 O X U z ¢ O m 7 ¢ N W Y ¢ ] r < W W N O ¢ J Z ¢ W W S 3 0 i 3 ~ Y. _ru y< OoF-ZoO 0 Ni < ¢ — ¢ W ac < O < r- 3 Y J m N O O J 3 S < f- N J W U < 3 Lr N O SUB—BSMT. BASEMENT % IST FLOOR aNO FL001t T g 1ROFLOOR 4TM FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing CompanyName �� /� Check one: Certificate Z / Address 7 Z-'�� k N i6f,7 a-3 jQ' Corporation _ ❑ Partnership Business Telephone K G 3 d y3 JS3-;;;t ❑ Firm/Co. Name of Ucensed Plumber e INSURANCE COVERAGE: I have a CuffejRl liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 1No ❑ If you have checked yam, please Indicate the type coverage by checking the appropriate box. A liability insurance policy k Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee docs not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ nature of Owner or I hereby certify that all of the details and information I have submitted (o( entered{ in above appiicabon us true and accurate 10 ttte best of my knowledge and that all Plumbing work and installations perfotmed under the permit issued for this application will W in compliance with all pertinent provisions of ILIA Massachusetts State Plumbing Code ter 142 of the General. Laws. By.� S+pnalure of Ljcdnsodum er Title Type of License: 64asler Journeyman ❑ City/Town 00-7 07 NL License Number J 2 0 W Vf W u LL LL O Ir0 LL 3- J W m Vf Z O 9 W 0 N Z VI 0 W ¢ t7 O IL. 9 d Z m J d O C O F- H � ¢ s n W J Z IL c ¢ m J O I LL O m Z w LL O 6 O O Ir V W m ti < � V IL < Z J d a J Date.. .................. . A M Q Q NORTH TOWN OF NORTH ANDOVER �o PERMIT FOR GAS INSTALLATION � 9 �,SSAC14USEt4y .�r r Q'' This certifies that ...... ..'.:.':! ................. "' ,• a has permission for gas installation ........................... . in the buildings of .! ....... ............................. . f4 _ at ........................................ North Andover, Mass. ...... Fee..'.. Lic. No.. . ........ .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 111 Mass. V G DateZ-% . 19 99 Permit # 3� Building Location !/O 141144cofjzs��4Lt �[ Owner's Name ,� Type of Occupancy New/] Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑ Installing Company Name !'s�/3� moi' Check one: Certificate Address L �� / dJ U3G3� Corporation ❑ Partnership Business Telephone Jv,3 AU�33 0� ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a Curr liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes � No ❑ If you have checked Les, please Indicate the type coverage by checking the appropriate box. A liability insurance poilcyx Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge Laws. By T f License: W Ru mber Signature o cen umber or s atter Title sfitter g 7 ster License Number City/Town urneyman ORION NEI ME ME EISEN Iso 111 0 on ME MENEM monommommonsonsomm Installing Company Name !'s�/3� moi' Check one: Certificate Address L �� / dJ U3G3� Corporation ❑ Partnership Business Telephone Jv,3 AU�33 0� ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a Curr liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes � No ❑ If you have checked Les, please Indicate the type coverage by checking the appropriate box. A liability insurance poilcyx Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge Laws. By T f License: W Ru mber Signature o cen umber or s atter Title sfitter g 7 ster License Number City/Town urneyman Q D N z N V m 0 -4 O m r_ p z 0 a O m m m m N X m 0 x m N 1 N2 I Date .................1� ....... 7;� .......... A oz. TOWN OF NORTH ANDOVER W 10 4L PERMIT FOR WIRING This certifies that ..........r......:....':.:. -'......... ........................................ has permission to perform .................................................................................. wiring in the building of ..... . ......... ....... ................................................. at.... .......................... I .....-:' .......................... : .......... . North Andover, Mass. Fee,.. :? .............. Lic. No..y ?.G .. ....... I.......... 11 ......... ............ ELECTRICAL INSPECTOR L/ 05/12/99 11:23 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TIEC0A i•�0AWE4LTH0 MASS iQ S= Office Use only //ce DEPARMUVTOFPUBLICSAFETY Permit No. /(1 BOARD 0FFIREPRE1FVI70NREGUTATI0N.S527CMR120 �cn� Occupancy & Fees Checked, UVPPLICATIONFOR PERMIT TO PERFORM ELECMCAL 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) 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) 60 �„v��j �� �,q�,� oz d, Owner or Tenant /„?,J fL/L i' 77 zfw6 /J£/C j ■ r ■ Owner's Address Is this permit in conjunction with a building permit: YeseM No r7 (Check Appropriate Box) Purpose of Building A?eX j O . Pi / G, / Utility Authorization No. Existing Service Amps / Volts Overhead Underground M No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �7_ 7-17 r rh No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground El ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units I 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 Locala Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis JpNo. Hydro Massage Tubs No. of Motors Total HP rDTHER U /C2 Ar rN.4 lr&==Ca+trg Ptrsuatylotheregt�dMassadxsdtsGaualLaws Iha%eaw=tLiabItyhmx-=PchcynixJrgCar>pi&Coaagecrdsabsbr ecg>ival�tt YES NO lhaaesubmiwdvandptoo(of=neiotheOffie YES F&71 NO Ifjwhawdv1edYES, plea rd iaadetherpecfoaeagebydakingthe WpWiakbcx WSURANCE Er BOND OTI-)FR O (P we-spe y) �� ✓ g Esi� Vahx dBx>tiralait ait w Walkosh�cnl*RgjesWd Ra* Fs�al Signed uaxi rTr Ptnaltm of FIRMNAME -sv / '�� �^� `� /R/ �"� LiMWNTa -Sr C Lioer>9ee /za /GL' r -L D, ..S it l h ✓AA✓ SigM w B TeL Na —2 �2 L/ 7 D 6 7 A —2 % IVI c6/a,, p'**' SA- G A by /Z. £ �✓G��� /%/� i�/� Y � AIL Td Na OWI-4R'SDWRANCEWAN)R;lamawmdrttheLi mm theinstzane a sial thla**11tas m4iiedbyMawdiseas GarralLaws and dAnrysigtu taecnt zpamitappf cmmwanesthis re4manat (Please check one) Owner 71 Agent a Telephone No. PERMIT FEE $ I'll �l x No ` f NORTH 1O A AcMUSE� Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING 1 r This certifies that - " ...........:. '........................ has permission to perform ......- .....................:............................................... wiring in the building of..: �` .....�'-�`` / _��, �.., ...................................................... at............................................................................... .North Andover, Mass. Fee -?4K ... Lic. Na: ;% ............._ .a�,: .,%r ...' r.. �� ..,....... 2& /' ELECCRICAL INSPECTOR - 05/17/99 14:10 360.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer -N TIE60W0NWF.ALTHOFMAYS4CHU E77S OfficeUse�only DEPARTh1rNfOFPUBLICS4= Permit No. UV4 BOARD OFMEPREVEM70NREGMTIONSV7CMR 12-00Occupancy &Fees Checked 7 ,�,PPUCATIONFOR PERMITTO PERFORMLLE=CAL 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) Date rota Town of North Andover The undersigned applies for a permit to perform the electrical work described below. LocationStreet & Number } � ( ) l�h i�, .t,i/l�r,1� L Y]�t-�1, i' e it/ Owner or Tenant 1 -07 - To the Inspector of Wires: Owner's Address I Q'-/� �J,�--��/,/C �. �% Is this permit in conjunction with a building permit: Yes M—No F (Check Appropriate Box) C� Purpose of Building Utility Authorization No. / 030 Existing Service Amps / Volts Overhead Underground M No. of Meters New Service cb Ampsietc I Zyo Volts Overhead Underground ® No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work v`�,H/_i X44(� � T/ ,t,6 ea �/ L �l �l �i i c-- ,Ilo. of Lighting Outlets No. of Hot Tubs No. of Transformers Total I,No. KVA of Lighting Fixtures Swimming Pool Above Below Generators KVA t ground 1:1round 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 lnitiatingDevices 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 OTHER• WcdctoSmn hq)ectionD@kRegt)ested Rough Final Signed Lrxier ie Paralties ofperjtay: C FIRM NAME 7,41 4J /� bl 4/L G�` i�°�� LicaseNa Lioa - ll<&A yW �� © ['�r'Y Sipe Lo I=..!T o ,� k),yo I BtsitessTd.Na arl,k, V�a L L OL a A -11 1i r l LAJ Ai<TUNa �` —J 2__ OWNER'S RySURANCEWAIV RJ arnm4wethatthelioasedoes_ not them*zkdbyMassadiseasG nei-JLaws and flAmysigtnaecnt%p=nitappficadonwarsthisMwiffe ent (Please check one) Owner r7 Agent Telephone No. PERMIT FEE $ ...:.fir: .�: •._ CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit N„me., OHO 9 Dela 7 la 6 190 9 THIIS CERTIFIES THAT THE BUILDING LOCATED ON doff 1.3 6*186) WIAPAW rVOM R61 MAY BE OCCUPIED AS b4' ����lv 3 st+rQ ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO A11W b #t1sr °` p ADDRESS /o y ! 7 lrl �ti �• s"CMUS Building Inspector , W C W 57R C L -4 OC C y 0 Cr y = +� d0 C O y CD n m t7 C U Z ymo.� 3 0 n? O O y —1 _P14 0=t CD m = _� > >.0 C n -4 O z is CA 'Z3 O n W o_ CD y o 5 " ' . n CEJ C � r doCD fA c m o o m E CL m n� 0 _ SIA zoCL m CDcoa m aca Co ' o CD Cf) cr m C'D p CD o CD O co ca C CD y Q S3�. CDH civ CO) o �.CO p Cn CO) ® CD CD o C: CD a CD s= o ow W rB 7 d o O pGp < G t--' ,c^ G C. a '� r -x n z \ OG Z S- �� In G a G1 C ti Q °�' ) tz ��7fi 2 O O 4 1 O rA CD 1P N° 1551 This certifies that Date `-...... �.(:......9 TOWN OF NORTH ANDOVER PERMIT FOR WIRING has permission to perform ... ......-� .............................. 14 wiring in the building of.: t �.... r. ................... at .... C.... L.;.,;; -:`..fig= ........................... . North Andover, Mass. Fee ....... Lic. No. Y.ki. ....... ......,.� Qr ... �!..� ... Gi ELECTRICAL INSPECTOR 03/22/99 15:58 50.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TIEC0AA10AI1'L:r4427 Ql+llfASSXHV= Office Use only DEPARTMFIV 0FPUBLIC&4= Permit No. A%/ BOARD 0FFMPREVFM70NRE9JL4TI0M5rCVR 12-.00 Occupancy & Fees Checked APPLICATION PDRNff TO PLWORM=(MICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE Wr M THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 f (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Owner or Tenant To the Inspector of Wires: Owner's Address 164 f l — ,aw �' lR S LYS Is this permit in conjunction with a building permit: Yes M1 No F1 (Check Appropriate Box) Purpose of Building Utility Authorization No. LL -.2 2,V Existing Service Amps / Volts Overhead 1:1 Underground r7 No. of Meters New Service AmpS_-ZdaLJL6VoltS Overhead F7 Underground No. of Meters Number of Feeders and Ampacity Location and Nature ofProrosed Electrical Work 1'�L / OL1 kmio T ma24e, of Lighting Outlets No. of Hpt Tubs No. of Transformers Total KVA �Jo. of Lighting Fixtures Swimming Pool Above Below 17 Generators KVA _y and eround 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 htiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other t . of Dryers Heating Devices KW Connections T1s. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER - r � . e• tri - • 18• . • �.•- .:.t �WWMTXM, E#a6m Date E ValuecfDectrid Wak S Final 7iiA i G Lia�seNa, LicerseNo ��/ �� Busiresc TA Na 2 6 /ty Alt Tel Na d'J / —2172 OWNER'SIIN-SURANCEWArVR;Iama%k=diat rLicmxdomDdhaNettiert>,straxaa�c tx�ssivarualegirale a5teccgr¢edb NbsmdxEez Laws aodthatmys aecnthspeatr$appfiatmwa,,esthisra4munent. (Please check one) Owner Agent Q1 Telephone No, PERMIT FEE S Date ...l. / ?'. 7 A6.... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. a:. v.. has permission for gas installation . f!`'........ .... ..... . in the buildings of .. . v S .. ........................ . at ... 64 ! L-�; North Andover, Mass. Fee.'7 v 0 . Lic. No.. .-- GAS INS E 9 Check # `/ c 7169 MASSACHUSETIS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date kiG NORTH ANDOVER, MASSACHUSETTS -- Building Locations f l�" K� t� J �� 4", permit # Amount $j/ Owner's Name -Z6=-'� New ❑ Renovation Replacement Plans Submitted ❑ (Print or type) , pO J ` Check one: Certificate Installing Company Ivme _ �/�— �( / ❑ Corp. Address f�y k G 2 Partner. Business Telephone �irm/Co. j Name of Licensed Plumber or Gas Fitter "'� e-) INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes O' No If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1:3 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 Agent I IIa euy ccnny LIM an or ine aetaiis ana intormatnon i nave submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ins ions ormed under Permi Issued for this application will be in compliance with all pertinent provisions of the Massach s s St as ode atyQ Chapt 142 of General Laws. City/Town !APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitte Plumber 3 Gas Fitter License Number �4aster rl Journeyman � w � rA N a ~ a a z O w GC7 U w w Q w x w z O F z 91. 0 a z w > w F z F z x w W Cw7 p > cF� W V �j W Q w Q rx .. Q z w ov�° a° SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8.TH. - FLOOR (Print or type) , pO J ` Check one: Certificate Installing Company Ivme _ �/�— �( / ❑ Corp. Address f�y k G 2 Partner. Business Telephone �irm/Co. j Name of Licensed Plumber or Gas Fitter "'� e-) INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes O' No If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1:3 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 Agent I IIa euy ccnny LIM an or ine aetaiis ana intormatnon i nave submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ins ions ormed under Permi Issued for this application will be in compliance with all pertinent provisions of the Massach s s St as ode atyQ Chapt 142 of General Laws. City/Town !APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitte Plumber 3 Gas Fitter License Number �4aster rl Journeyman 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office ofinvestigations Uf 600 Washington Street Boston, MA 02111 www mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet I ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required] t These sub=contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other r---••••• •••••• •••••.�..:. ai:s.,. r.: —u ' 4""_, Ln: 3u, me sectionDeinpr en4}R^nb :ne'SS workers'coin Sa OIIPolicy. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the. name of the sub -contractors and their workers' Policy coinP . Ii information. Iam an employer that isproviding workers' compensation insurance for my employees Below is thepolicy andjob site information. Insurance Company 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 c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date Phone #: 11 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: 0 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee s; defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pernait or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their � self-insurance license number on the appropriate line. ` City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. . The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washmgton Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26=05 Fax # 617-72.7-7749 mrww .mass..gov/dia Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Inspector 1600 Osgood Street North Andover, MA 01845 RE: Insured: Property Address: Policy Number: Date/Cause of Loss: File or Claim Number: Paul & Margriet Rokos 80 Windkist Farm Road H P2035818 7/3/2014, Lightning Damage Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Pat Garrett On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Signature and bek ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Property Address Policy Number: Date/Cause of Loss File or Claim Number: Paul & Margriet Rokos 80 Windkist Farm Road HP2035818 12/10/2014, Wind -Driven Rain 30583-W Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Wade Anderson On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. l� V) -/ Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Inspector 1600 Osgood Street North Andover, MA 01845 RE: Insured: Property Address: Policy Number: Date/Cause of Loss: File or Claim Number: Paul & Margriet Rokos 80 Windkist Farm Road HP2035818 3/3/2015, Water/Ice Dams 31346-P Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Pat Garrett On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Signature and t ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Location 6tliyi�i r No. ``Date a 97 N° TM TOWN OF NORTH ANDOV R s1, Certificate of Occupancy $ } �o Building/Frame Permit Fee $ !� �. cMus `� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ 74 Water Connection Fee $ /p$2.� TOTAL in Inspe for (� 05/01199 08:53 1, 9 2 5 Div. b e Works U. z V` s J W m ■ W IV iL '' ►V Z 0 N 0 L u ulz g W 0 0 Q O C u m m m u' Z W 0 Z Z RFs Z-3 t = Z . 1 W w W M l m w J F' F, m a Z m 0 H 0 > < 0 0 W 0 Z 0 C > W F. 0 .. _ F ` x 0 IL d W Z < O W N 0 z a = J\ OW K 1- K 3W J U u < (k m m Jo Z z Z a 0 < 0 k, i 0 W 0 < W f N J_ Mc Hr J 0 0 ;0 z 0 I I Z 0 N W ►' N J N W 0 Z 0 F. m 0 0 0 w 0 �W. 0 �W. 0 m �IS�< N LL Z �0zzz J �U �U 'U 0 l m W■ 0 s 0IL p W 0 �% 0 0 0 0 F 0 0 f 0 Z 0 N 0 0 0 J i 0 U ' N 0 W 1� 0 \ H W Z e F LL 0 OJ 0 O N ;FAkL y d W yFj < N Z 4 110 ;l. 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O CD O dc CD ju ON b 7 m 0 b c co 0 um o_ co C oCL ce V ! N O� 0 Cn C 1,50 0 01EL =_ ..< m Q .00CO3 m mC o m c m ?� H .•y o M O g T CD aid O_ y V0 o N o -1 7� 0 Zyn .Z O O C, 'fl C om ate..: o o o CL d y Q CL Iff �0 o � COO :� O W . An ocn•�0 000 Co. o. 03 N CD cn .-O ► (Al1( W ate. o m =Ca CD 0 ..:.,. o �; gym. - a0 Cl) C O m .pw 7 :R O o►r1 ~ w Crs7 0 G r So - C M ^ cn L` z � x lu y 0 0 c FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: PhoneLLZ:,2�� LOCATION: Assessor's Map Number /0 L Parcel _ Subdivision,. /:S �,��� Lot (s) 13 Street L'���1/ %� r2Q 102 St. Number eo RECOATIO S O TO AGENTS: 7 z Conservation Administrator Comments Planne Comments Use Only************************ Date Approved Date Rejected Date Approved Date. Rejected Date Approved Food Inspector -Health Date Rejected Date Approved Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections uc` c) ::;/ //9 % - driveway permit /77 F ' re Department Received by Building Inspector 7 Date 03/13/98 13::7 FAX 508 6889556 :l NORTH ANDOVER Growth Management Bylaw Exemption Statement Town of North Andover Building Department ihis forth $hall be used to assist the Building Departmentin their detem+ination of exemptions under section 8. 7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant an Building Permit (below) Addres3 of Property for Permit (below ,w s �•4�� GLC Fe Gj,�,�L,��f Fes•, Map and Parcel:/00YPurpose of Application (check below) " Pha a tuber of Applicant Single Family ._ '.Two Family -C8;?-23zo I the undersigned applicant for the above property attest that the attached building permit for which this form ig Completed doer, comply with the EXEMPTION section 8.7.5 of the North Andover Growth. Management Bylaw. I also understand providing this form does not absolve Rte or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is sublea to review by the Building Dcpattment and is only officially accepted when the Building Permit I% Issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above tot and the work as applied for on the above lot. in the building permit application and associated attachments, complies with one or mora of the following seasons as indicated by a check mark. This is an application for a building permit for the enlargemem restoration, or reoanstruction of a dwelling in existence as of the ttfecnve date of the by-law. provided that no additional residential unit is created, 4aw7l* lat(s) werelwas created prior to May s, 19% are exempt from the provisions of this 5ectian 8.7 of the Zoning • This application is fru dwelling units nd/ o for low aor m oderste income families or individuals. where all of the condihom of 8,7.6.c are mer and/or represents Dwelling units for senior residents. where occupancy of the units is iustrirxntf to senior persons puough a property executed and recorded deed resinchon running with Me lino. For purposes of this ZCQQn 'senior^ shall mean persons over the age of 55. Thin application is a part of a development prolect which voluntarily agreed to a minimum 60% permanent reaucdon in density. (buildable lots), below the density, (buildable lots), permitted under Zoning and feasible given pre environmental c Ondinons of the tract, with the surplus land equal to 21 16231 ten buildable acnes and permanently deslgnated as open space and/or farmland. The land to bo preserved shall be protected from development by an Agncultural Preservation Restnction, Conservabon Restriction• dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This Wlieatlon represents a tract of land extstingand not nerd ey a Developer in common ownership with an aojacl nt panel on the ettemwe date of thrS SecJon 8.7 shall rtccive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single famiry dwelling unit on the parml. Thu application represents a lot which is ready for building penmits.(i.e. all other permits from all othe- board^, and commissions have been received and the protect is In compliance with those permits), aria crit Oevtlopment Sc1%duce does not accommodate issuing a building oanmit in that Year. one building permd will be issued per Year per Cevelooment until stun time as the Development Schedule acc-jrnmodates issuing building permits. Applicant must supply approved form U wrin the EXEMPT10N. Please provide any and all information that would assist the Building Department in making 3 •Ietermination' that your application is allowed one or more of the above EXEMPTIONS. 8y signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further 1 understand that the submittal of misleading and or maccurate information, or the checking off of an above item which does not Comply. whether done to my knowledge or not, is grounds for refusal a Building Oepartment to issue a Building Permit. Aq,4-bodtO nor or Authonzed age signed the Anacned Hui in Penmrt to Reis conn must be attached to the Building Oermnt upon application for such oermit. Z U01 7 • .. • off_ '9�-S:F: ! 222 -' 22 �- � niS 4 216 i ice' P I' ,_ / � i 2j8 220228 222 Tp10- 0 224 FNp 3 ,0 • ! ` _ - - 252 i y26 8 3 22 3a' 230 232 t" OEv AGE 234 7 14 236 IF 238 80% q� 15 A' 1 !//�// 8501E ES / 2a8 SU NCH 240 10PS51AR0NuN0 TRENC 3 .. 20� tjoll pt10N• air E%0 L 242 ID 10+0011+00. { 244 RM \ R® \ 2A6 \ MARK. 250 SET. B�PCOf SZa5E82 tag 1 ,OF A5.82 7 GEORGE PERNA DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 OORTk OF — t o � ,e. ti e O L O T � A DRIVEWAY PERMIT Date: '30 / � � ? (LOCATION: (BUILDER: B6 6-d ;,7,J 4,, t, t� (- � fvu phone: Telephone (508) 685-0950 Fax (508) 688-9573 'OWNER: ���,° �� � �� L L � phone: 6 0 z — 23 2C The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. ■ Remarks: Approval: N-0 741 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 191_ Application by the undersigned is hereby made to connect with the town water main in /�/GtC/�lIL1 Street, subject to the rules and regulations of the Division of Public Works._ The premises are known as No. or subdivision lot no. Owner kddress Contractor (0S r� Address / Applicant's Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to CN ►�'u `` t P /-y,Z L r% C to make a connection with the water main at (.�I L subject to the rules and regulations of the Division of Public Works. Inspected by Date 5,4,ec-� / 1 Street Street Board of Public Works By :Z: See back for rules and regulations RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be 1" type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4'/2 foot rod and brass plug type cover. t MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 2-12-1999 DATE OF PLANS: or 2 family, detached Other (Non -Electric Resistance) TITLE: Lot -13 Windkist Farms Road 6 Permit # J C �r-/,' Necked by/Date l` i COMPLIANCE: PASSES Required UA = 679 Your Home = 652 Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 2396 38.0 0.0 72 WALLS: Wood Frame, 16" G.C. 3481 15.0 3.0 233 GLAZING: Windows or Doors 670 0.350 234 DOORS 35 0.350 12 FLOORS: Over Unconditioned Space ------------------------------------------------------------------------------- 2127 19.0 101 COMPLIANCE STATEMENT: The proposed building design represented in these documents 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 1250 of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designe Date_ 0 NOIR AIIIAO�U SAVVOH ANI-A -Ao dasilni�a r -t I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I_ _I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I r ! ! 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