The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 81 HICKORY HILL ROAD 4/30/20181� N2 I M This certifies that Date .... ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ............. 11%.1 ..... ............................................................. has permission to perform ....... < .......................................... wiring in the building of .... .......................................................................... at ... ..................... . North Andover, Mass. Fee�% ............. Lic. No-�V'.' 9/ . ...................... ........................................ I ell I -- ELECTRICAL INSPECTOR 10/06/99 16-20 40'00 PAI PINK: Treasurer WHITE: Applicant CANARY: Building Dept. �. TBEC0Mt10AWE4LTH0FAUMCHUSE77N Office Use only DEPARTAMWOFPUBLICS MY Permit No. //90/ BOARD 0FFMPREVEW0NREGMT10A•S527GMR IZV0� Occupancy & Fees Checked .4/0�...--�.. APPUCATTONFOR PERMIT TO PERFORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DatZ4 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes No � (Check Appropriate Box) Purpose of Building _14,6- S -,-D -e ti -(-) A-4,— 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 Work V -OD A -frb-A- C � No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundg1:1round 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 Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local r7-1 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' htsur=Com� Rm iantt3ot cm#mu>ts&Awadm&GmmalLaws IhaveaamatLialAkh>sur mPbbyitrh&gCotrpicleageccilsE:r st�ati�alac�malert YFS NO IbaNesthmif advandpoofof metotheO &>a YES r LVNO If�uuhawdedWYES pimmdc*ttretypecfaner�bydrdmglhe INSURANCE LvJ BOND LJ 0111RI FlmeSpeafy) ExpiraionD* Estirn dVaha dE1mhc IWotk $ Work%)Shat Z1 r hspectiwDr*R� Rough Z�� 1 � Fitlal rrxq�-m L,;0=Na M 5i B Td -Na < AkTe1Na OWNER'S . WAIVER;IamawmfttthL-Lxnwdncsna theinst,-,rw o,=F orl,st alepvArtastacpzWby1vSa5sad aftCmaaiLam antitbatmys�r�taeonlhs pam6app&�onwaic�sth's tagtm��errt. (Please check one) Owner ® Agent r7 ` / Telephone No. PERMIT FEE 1T� ►�� Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that. has permission )).(ALL p son for gas installation .............'(?......... . in the buildings of.', 6(,.k :5p --.. • .. nn ....... _ . r ... . at ......... �. �,� �, , f<; North Andover, Mass. Fee �r��.. Lic. No.. AGASINSPECTOR Check #; jT 8453 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYI f __- MA DATE PERMIT # JOBSITE ADDRESS 511(�� l_ _ 14-t( {2 OWNER'S NAME �Jo e :. b; c� OWNER ADDRESS h / s z C-ur - K TE FAX TYPE OR PRINT OCCUPANCY TYPE COMMER __I EDUCATIONAL j RESIDENTIAL CLEARLY NEW: Q RENOVATION: _ REPLACEMENT: 1-3 r / .- /0 -- /j LANS SUBMITTED: YES [ ]__! NO 7'0 APPLIANCES'l FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER I FIREPLACE FRYOLATOR FURNACE .._--- GENERATOR- GRILLE.- INFRARED HEATER) LABORATORY COCKS (! . _ _ _--r—.! F -7—I ._ �. .-- MAKEUP AIR UNIT OVEN POOL HEATER 1 ROOM / SPACE HEATER -- ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER — INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES -- NO D IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY �( OTHER TYPE INDEMNITY{ BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT �( SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. G� PLUMBER-1SFITTER NAME u�� lq�N/%�� a __. _. _.,.._. -- -- --� I LICENSE # : 3�S I SIGNATURE MP _ I MGF__ ( JP J JGF LPG] Q CORPORATION __, # 6_- _ PARTNERSHIP 0#� __. ,�� LLCJ# COMPANY NAME: ADDRESS 3 j CITY(. _ -r�z, —) STATE '1ZIP (TEL FAX EMAIL CELL "s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington. Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADDlicant Infarmatinn Name (Business/Organization/Individual): Address:_ :?" z ��Si 17;�-' '�_36 ,z,;,- -> Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ElI am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. i am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site %reformation. Insurance Company Name: 'oiicy # or Self -ins. Lic. #: � � S� /-�y G; �' T Expiration Date: 31_2 L,, 3 ob Site Address:_ �� City/State/Zip:.c�✓� kttach 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 ine 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 if up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. i ;nature: Date Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-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 permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple 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 burn 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 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www,mass.gov/dia W -ul U1 ul, < F- z 2 - 4p - ubis 0013 D LUv3 r:. w .0 ..\ , ?J) 4;q Ljj- to, ti: r C3 43 o hu KL. L CP i rA U) C7\. cm 4-0 f,—,- ul Ca�- CM < m Us I I 00 u 1-4 U- EL (n r vi il-51 -e MI L&I< tu < ma Z' -2tu -T U) rz IL 10i C) J U3 .00 Ln > 0, H LU LU r-4 C3 Ln LL w o k7 L53 WO LU En ula� UJ z 0 ul, < F- z 2 - 4p - ubis 0013 D LUv3 r:. w .0 ..\ , ?J) 4;q Ljj- to, ti: r C3 hu KL. L LL rA U) C7\. cm f,—,- ul Ca�- 0 < m Us I I 00 u 1-4 it 2 - 4p - ubis -T- M ti: r C3 hu rA U) C7\. cm f,—,- ul Ca�- 0 < m Us I I 00 u 1-4 U- EL (n r vi il-51 -e MI L&I< tu < ma Z' -2tu -T rz IL 10i C) 47 .00 Ln w it 2 - 4p - ubis -T- M di hu rA U) IWO cm EL (n il-51 IU7i U)=) < j 171 0 IL Ial IL C) .00 Ln w CO u 0 r-4 U. CQ U) W L53 WO LU En ula� UJ z 0 Lu t ink.- o. L) U) d. min. LL > 0 0 Zco N co < CL D Ln LU tit. LL it 2 - 4p - ubis -T- di rA IU7i Co w CO r-4 W C3 Lu t w > 0 0 Zco N co < Ln LU tit. LL w o V) CO LD < :) CA z 0.Co. :2 PL C) r< Co. Date .j7—`/--�?l ....... (0' TOWN OF NORTH ANDOVER PERMIT FOR WIRING .......................................... This certifies that has permission to perform .......... ...... ..... wiring in the building at ... .......... .... A4.e�v North Andover, Mass. Fee..... Lic. No................................... ........ C;71 ELECTRICAL INSPEC"rOR- Check # a Vo 8260 f r d Commonwealth of Massachusetts Official Use Only �j� .f Department of Fire Services Permit No. Occupancy and Fee Checked U BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her�Dtention to perform the electrical work described below. Location (Street & N mber) t L(Z Owner or Tenant V ° Telephone No. IS Owner's Address^ Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followinz table may be waived by the Inspector of Wires. a No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of OR Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons "' " KW "'" No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE a BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: OPELyA Irvt 1� S L t.J -� LIC. NO.: 35094 -Er Licensee: LIC. NO.: (If applicable, e ter "exemp " in the license number line.) f A4- �j � � 70 l Bus. Tel. No.: 17,9-47-3-"07 Address: r��/'� �,r4� � �)�01� Alt. Tel. No.: c93 ` 317- `[ 933 *Per M.G.L c. 1� 47, 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 ❑ owner's agent. Owner/Agent" Signature Telephone No. FP—ERmTFEE: $ 6 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): J U r Address: S1rA/ City/State/Zip: KW SvA N/ Phone #: Q7� '4 Z3 "9cfD % Are you an employer? Check the appropriate box: L ❑ 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. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me in any capacity. [No workers' comp. insurance 5 required.] 3. ❑ I 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 *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pa( and penalties of perjury that the information provided above is true and correct. �� Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Date..). TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING *I This certifies that has permission to perform ........... plumbing in//the buildings of. .................. at ..P. '4 . A / ............. , North Andover, Mass. Fee. 2)0 .... Li'c. No,3216 .. .......................... �41 PLUMBING INSPECTOR Check 8352 C MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING a - City/Town: MA. Date:— Old Permit# s' - 1 Building Location: &LZ -d Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes*No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only r Owner ❑ Acient 1-1 gnature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted application are true and accurate to the best of my rnnuwieuye anu inat an piumomg worK ano mstanations pertormed under the permit ' sued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 oyhe General Laws. �7 By Type of License: Title lumber ?ity/Town A57master ,.PPROVED (OFFICE USE ONLY) ❑Journeyman License Number: DEDICATED Z SYSTEMS y W H z Ln Z HH a M Y Q H Z 0: Z Q U w U' Q LAZ LU aC D O Q� Z W H N V) W O a x W o F' Q D: a W D a W V) e= 0 0 3 x Z u. 3 J Z = = Y z D: W 3 3 ° W W a> W v a m a a '' 0�>> o 0 0 m o c� g 5 °o: v=iLU 1W- Z a a a= 3 3 3 o 6 V) W 6"<<1A a 3 x° x &nV1 SUB BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4T" FLOOR -5 R FLOOR 6T" FLOOR 7T" FLOOR BT" FLOOR ` Check One Only Certificate # at Installing Comp ny Name: ' ` Xorporation _ Address: %.- b, City/Town: State: ❑ Partnership Business Tel:m- l% � Fax: �� - X 84 ❑ Firm/Company Name of Licensed Plumber: - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes*No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only r Owner ❑ Acient 1-1 gnature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted application are true and accurate to the best of my rnnuwieuye anu inat an piumomg worK ano mstanations pertormed under the permit ' sued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 oyhe General Laws. �7 By Type of License: Title lumber ?ity/Town A57master ,.PPROVED (OFFICE USE ONLY) ❑Journeyman License Number: 0 m z 0 H U W a a C7 O a. C7 F - cn v. A a q w z U O ZO a a p z w a w z W � c7 t— Z W w z U a � a z , 0 F � U W z U a a z 0 m 4 Dat6.-. f - /.... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for, gas installation in the buildings of . D'.JI.-a.s ............................ at . �/. .,h(4 AkO�).. A,11 ........... North Andover, Mass'a Fee... aO--Lic. No.. 52o .. ...................... Ve q o�d GAS INSPECTOR Check # 7262 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING MA. Date: Permit# Building Location: Owners Name: / f Type of Occupancy: Commercial ❑ Educational ❑ Industrial Institutional ❑ Residential New: ❑ Alteration: F] Renovation: ❑ Replacement: Plans Submitted: Yes [1o 4 FIXTLIRFS WFW- Y = m= O W w U to H 0= it w O z H g z 0 Lu w W O Q H in > w W z m �0 w CL O W= x a w~CO) Q > V W z W W W 0 J w z I— H O N= z W J C'► W W Z W = W W W O IY lX 0 o c u. a -J c7 0 w _ � m Q.t W o O z 0~ L> z �- = > > > 3 0 a. IW- SUB BSMT. BASEMENT JST FLOOR 2 FLOOR 3 FLOOR 4TR FLOOR 5 FLOOR 6 FLOOR 7 FLOOR a FLOOR Check One Only Certificate # Installing Com any Name: r Q `j ? Corporation �j� Address f J c� H� City/Town: / / �' _ State: %% ❑ Partnership /� Business Tel: �� j (� Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: ' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YesXNo ❑ If you have checked Yes, please indi to the type of coverage by checking the appropriate box below. i A liability insurance policy 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ By checking this box ❑; I hereby certify that all of the details and information I have submitted (or enteredVpgarding this application are true and "UUU1 dLc w 111e LAML o1 my nnowieuge anu mat an pwmomg worK and mstanauons per rmed under the p6rffiit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code ,;,.Id Chapter 142 of Gen. -7,0 Laws. Ty a of License: By plumber AqAhd Title ,Gas Fater Signa ur o ensed u ber/Gas Master Cit frown ❑Journeyman License Number: _ / y APPROVED (OFFICE USE ONLY) ❑ LP Installer z 0 U W a C7 O CL a C7 F w cc va w � t- O o ¢ a Q C7 m w � z 5 U O a m a Q a cwi� F x a W w U a W a I r J z 0 F � W z x U w x a Q z w Date. ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that. AD:% S ! has permission for gas installation ...F -S. r. 7' ............ in the buildings of ,�4 A'I '. J. ........................... at ... North Andover, Mass. Lic. No... Fee. ... GAS INSPECTO��* Check# 5876 MASSACHUSETTS UNIFORM APPLICATIO N FOR PERMIT TO DO GASFITTING r-� (Print or Type) Date �'' �lv. 07 Permit # S -p %G BuildingLocation % i L i�."t /',' �L r� % T _ / d</Owner's Name -0, o Type of occupancy ,'-Z L, Ir a New ❑ Renovation ❑ �. Replacernent G Plans Submitted: Yes❑ No ❑ CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC Installing 5 South Summer Street Address Bradford, MA 01835' 9.78-372-9999 (phone) 978-372-0882 (fax) — Business Telephone I_ic. Plumber: T�hti �• d��cct�i L Name of Licensed Plumber or Gas Titter Check one: Certihcate `'Corporation 6 00 C Partnership Firm/Co. 41SURANCE COVERAGE: have a current liability insurance policy or its substantial. equivalent which meets the requirements of MGL Ch. 142. Yes 2r No G You have checked Vis. please Indicate the type coverage by checking the appropriate box. liability insurance policy m Other type of indemnity p gond O IWNER_'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by hapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ gnature of Owner or Owners Agent ereby.certify that all of the details and information I have.submitted (or entered) in above application are true and accurate to the best of r , owledge and that.all plumbing .work and installations performed under the er issued for th appli tion will be in cbmplia.na:3 ,,vith all rtinent provisions of the frtassachusetts State Gas Code and Chapter.1:42.ofpt e ener La T of license' Plumber gnature of Licensed ?lum or Gas Fitter le Gasfitter Master. License: Number ylTown Journeyman — 'D (OFFICE USF ONLY( s in ¢ W w Y Z N . W Uj N. w O U m H = n i o u a ¢¢ a s �" w W O - d rz N U W h Q ¢ 0 W . W ¢ W 0 .W W z <_ ¢ ¢ W v ¢ w F.. W = H ¢ C7 ►- Q Z W _j - F- < Z C }. W "" W )- N O m > Z 1L O 1- W J j., W O !A = a W> ¢ W Z. Q ¢ Q Q O O W O a1 ►- ¢ _ O 0 2 LL 7 O 0 J U C > G rL F- O Sua=as MT. BASEMENT 1ST .FLOOR 2ND FLOOR I 3RD FLOOR _ I 4TH FLOOR I STH FLOOR 6TH FLOOR 7TH FLOOR -�H CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC Installing 5 South Summer Street Address Bradford, MA 01835' 9.78-372-9999 (phone) 978-372-0882 (fax) — Business Telephone I_ic. Plumber: T�hti �• d��cct�i L Name of Licensed Plumber or Gas Titter Check one: Certihcate `'Corporation 6 00 C Partnership Firm/Co. 41SURANCE COVERAGE: have a current liability insurance policy or its substantial. equivalent which meets the requirements of MGL Ch. 142. Yes 2r No G You have checked Vis. please Indicate the type coverage by checking the appropriate box. liability insurance policy m Other type of indemnity p gond O IWNER_'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by hapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ gnature of Owner or Owners Agent ereby.certify that all of the details and information I have.submitted (or entered) in above application are true and accurate to the best of r , owledge and that.all plumbing .work and installations performed under the er issued for th appli tion will be in cbmplia.na:3 ,,vith all rtinent provisions of the frtassachusetts State Gas Code and Chapter.1:42.ofpt e ener La T of license' Plumber gnature of Licensed ?lum or Gas Fitter le Gasfitter Master. License: Number ylTown Journeyman — 'D (OFFICE USF ONLY( s Location �/ < < bR 2C-1 No. _' � Date,?, .r NORT1y TOWN OF NORTH ANDOVEF O p Certificate of Occupancy $ Building/Frame Permit Fee $ %�G• _ sACNUs Foundation Permit Fee $ •„ ... Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works ill v OL V) Z o Z U 0 0' - p U U .+ z W 2 0 t,J U; DO •" 4 V rn V U ti h M p c O � LQ w' W w W pzp p % zz 64 ol v OL V) Z o Z U 0 0' - p U U z V Lev a z N W nil r w en rn in— I N949 s .+ z W 2 0 t,J U; DO •" 4 V rn V U ti h M p c O � LQ w' W w W pzp p % zz 64 ol iii R Z 7 Z U 0 0' - p U U iii R Now Add a y 4a I JER �I Z w O ¢�u w o A -u w° z In cf)U cn 0 z z A c ° w Q� N C U w a z c�° w � w C-4) U 0.4v� w , c2 cn w O w z d C� c�° w H w � A w � w' o z cn v Q o C/) C2 `TAG O.L x * � UJ z CL Ilk �: c as c ;,= g N w v .a' CLC C so o � N D S :Ea �-CD o v CD Q �� m o c. y v �Eo Voo L3 CM U r.. a . mm O N O m J C � m O t� N O N CLU ` Q, = z m cc O U6 O O ►�V 0 I c cm co Q C LA m � .E CD o a� CD 3 0 O L cc 0 cnQ y C C *- C CcC �C. O Ce c Z CD CL — �� C !C _O) 0 _o C/) U) IrW w LU ui U) :oQo m Q� N C � a o COD W C OrL..�= LCL Nm l�0 LC r.+ •d=_ C F N w �E v v cc.D2�N V m 0.O� C CODd " m • O 2 .0 0 06 O U6 O O ►�V 0 I c cm co Q C LA m � .E CD o a� CD 3 0 O L cc 0 cnQ y C C *- C CcC �C. O Ce c Z CD CL — �� C !C _O) 0 _o C/) U) IrW w LU ui U) KE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ****************APPLICANT FILLS OUT THIS SECTION APPLICANT at �t kv- PHONE 9 7,? '6 9-7- U 3-Y' LOCATION: Assesses) -Map Number d ��,. PARCEL-_ SUBDIVISION UL fs�[, 4111 LOT (S) STREET 14111'CLA, ST. NUMBER *******OFFICIAL USE ONLY*************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRA R DATE APPROVED I6 DATE REJECTED - COMMENTS r TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm ATE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: -r,D 6 4 r::�+ (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NOTICE TO EMPLOYEES NOTICE TO EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: ZURICH -AMERICAN INSURANCE GROUP ------------------------------------------------------------------ NAME OF INSURANCE COMPANY ONE TOWER SQUARE HARTFORD, CT 06183 ------------------------------------------------------------------ ADDRESS OF INSURANCE COMPANY (GZSUB-380X311-5-99) 041199 TO 041100 ------------------------------------------------------------- =---- POLICY NUMBER EFFECTIVE DATER W G LEAVITT & SON INS 228 MAIN STREET* STONEHAM MA 02180 ° --- ----------------------- ---------------------------------------- NAMEOFINSURANCEAGENT ADDRESS PHONE a— TARA LEIGH DEVELOPMENT CORP 185 HICKORY HILL RD o NORTH ANDOVER MA 01845 o------------------------------------------------------------------ EMPLOYER ADDRESS m — ----- — — ----- — -- — — -- ------------ EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) — DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the x ----------------------------------- NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER 014193 W20P 1 H95 * ZURICH -AMERICAN MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 9-12-1999 or 2 family, detached Other (Non -Electric Resistance) DATE OF PLANS: 9/13/99 TITLE: Jack and Marsha McManus PROJECT INFORMATION: 81 Hickory Hill Road North Andover, MA 01845 COMPANY INFORMATION: Tara Leigh Development Corp. 185 Hickory Hill Road North Andover, MA 01845 COMPLIANCE: PASSES Required UA = 88 Your Home = 79 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 396 38.0 0.0 12 WALLS: Wood Frame, 16" O.C. 374 19.0 0.0 23 GLAZING: Windows or Doors 103 0.350 36 FLOORS: Over Outside Air 240 30.0 8 HVAC EFFICIENCY: Furnace, 90.0 AFUE 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 has been determined using the applicable in the Code. The HVAC equipment selec shall be no greater than 125 of the sections 780CMR 1310 and J4/4.T Builder/Des the cooling load if appropriate Standard Design Conditions found d to heat or cool the building ign load as specified in Date q1) ?1 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 Jack and Marsha McManus DATE: 9-12-1999 Bldg. Dept. Use CEILINGS: 1. R-38 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-19 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.35 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: 1. Over Outside Air, R-30 Comments/Location HVAC EQUIPMENT EFFICIENCY: 1. Furnace, 90.0 AFUE or higher Make and Model Number THERMOSTATS: Adjustable thermostats required for each HVAC system. AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. 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 in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure -sensitive tape may be used for fibrous ducts. 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. MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------- Y R 185 Hickory Hill Road North Andover, MA 01845 TARA LEIGH DEVELOPMENT CORP. Thomas D. Zahoruiko, President Real Estate Deuelopment, Construction, Consulting Agreement for Construction Services Prepared September 10, 1999 Parties, Contact Addresses, Telephone Numbers: Tel: 978-687-2635 = Fax: 978-689-2310 E -Mail: tomz@mediaone.net Constr. Spvsr. ,# 055417 HIC # 107679 Fed. ID #04-3212726 Client: Jack and Marsha McManus Contractor: Tara Leigh Development Corp. 81 Hickory Hill Rd. 185 Hickory Hill Road N. Andover, MA 01845_ North Andover, MA 01845 978-689-4453 978-687-2635 Location of Work: 81 Hickory Hill Rd. North Andover, MA 01845 Description of Work to be Completed: See attached Proposal dated September 10 , 1999 Attachments: Proposal dated September 10_, 1999 Plans dated . September 10 1999 Limited Warranty Work Schedule: Payment Schedule: Proposed Start Date September 15, 1999 Proposed Completion Date October 8, 1999 At time of Agreement On Start Date Completed Frame Roof, Windows Complete Siding, Rough Mechanicals, Insulation, Drywall Complete Total as Proposed 10% $2,400.00_ 20% $4,800.00_ 20% $4,800.00_ 20% $4,800:00_ 20% $4,800.00_ 10% $2,400.00_ 100% $24,000.00 1 Permits: By this Agreement, Client acknowledges its authority and authorizes the Contractor to apply for and acquire all necessary construction -related permits (From time to time there are additional permits and approvals required prior to building permits, which have not been provided for in this Agreement. These may include Special Permits, Conservation Commission Conditions. Planning Board Approval, or Zoning Variances, among others, and these are not included, if necessary). Unless specified in attached Proposal, costs of permits, as well as any costs for application or documentation required to apply will be passed through to Client, over and above the terms of this Agreement, for reimbursement. Client acknowledges that no work can begin until all necessary permits are in hand, and that Contractor will use good and reasonable efforts to acquire the necessary permits, but Contractor does not control the timely issuance of said permits. General Conditions & Definitions: 1. This Agreement constitutes the entire agreement. 2. Any changes are to be documented in writing and signed by all parties. Any changes will be paid for at the time of the change request, prior to the changed work being undertaken. 3. Additional work will be billed at the rate of $38.00 per hour for licensed labor, $26.00 �& hour for common labor unless otherwise agreed. 4. Work sites will be left in equivalent condition to those existing prior to contracted work; unless specifically agreed, no existing site conditions will be improved. 5. Any specific work hours which are restricted by local statute, agreement or association, and which adversely affect contractors' normal work schedule (8 hrs/day incl. Sat.) will cause completion time to be extended accordingly. 6. Completion time will be extended due to any delayed inspection services, beyond those specified by the current Massachusetts State Building Code. 7. Contract will be considered Substantially Complete when all work has been initially completed; repairs and warranty are beyond the scope of Substantial Completion and final payment will not be withheld due to repairs and warranty items. 8. Non-payment or delayed payment according to the Payment Schedule will result in work stoppage for the duration of any payment delays, and completion time extended accordingly. 9. Late payment will result in a finance charge applied to the entire balance due at an annual rate of 18%. Additional Conditions: 0) Additional Conditions for Residential Home Improvement Contracts ONLY: 1. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 2. All home improvement contractors and subcontractors shall be registered, and any inquiries about a contractor or subcontractor relating to a registration should be direQted to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617) 727-8598 3. Client is entitled to a three-day right of cancellation under MGL c.93, ss48; MGL c. 140D, ss 10 or MGL c. 255D ssl4, as may be applicable. 4. Client is entitled to owner's rights and warranties under the provisions of 780 CMR R6 and MGL c. 142A. 5. Unless otherwise specified or notified, there is no lien or security interest given on thR:rci dence as a consequence of this contract. 6. Any and all necessary construction -related permits are necessary for work to commence. 7. It is the obligation of the contractor to obtain such permits as the owner's agent. 8. Any owners who secure their own construction -related permits or deal with unregistered contractors shall be excluded from access to the Guaranty Fund. 9.The contractor and homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in MGL. c. 142A. Owner Contractor Agreed this day of , 1999, by: Client Contractor 3 0' — 4Ja�° cr' oz m >, O m o a x o> 0 m� �u Li 3 3 V � «. 121 0 N m k, a v 0 %0 Zi. 14 a v 0 �y-by-yy 15 �S 506 601 L U1LL6 001 MORTGAGE ,SURVEY PLAN LOCATED /N SCALE / "r _4o' DATE ; i l�- Scott L. Giles R. L.S 50 Deer Meadow Road North Andover, Mass. �1 L -o -r- 3 8,z, 33 8 r=. P R0 90.5c D P,00M t Pb RCN /aDD 1z 10 N 1 cad. c+o r 1� s G bG0 ?✓� N � tr tr �. Opt Q a TO E = �lrr Ca". AND ITS T/TLE INSURER THIS L OTISumt IN A FLOOD HAZARD ZONE �3.J5+�2,�ouu vwn 1�t e c / CERT/FY THAT OFFSETS SHOWN ARE FOR rHE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE /S FOR THE WITH THEZONING DETERMIN..4T/ON OF ZONING 1 DYLAWS OF CONFORMITY OR NON- CONFORM/T Yp�c,5-ills 1"y. A.--, mi�VF-: 0 ma, WHEN CONS MIMED. �'0�u u0' WHEN WX Location No. Date i A a EE NORTIy TOWN OF NORTH ANDOVER F n Certificate of Occupancy $ } ; Building/Frame Permit Fee $ ! ++•m .r '+ssuHu,Et Foundation Permit Fee $ titer Permit Fee $ Sewer Connection Fee $ M Water Connection Fee $ TOTAL $ .£ 111 L 2Itj s7 Building Inspector Div. Public Works r "Location ' f"L �J''' No. / i Date s p c.v TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ',SSA�NUSE<�' Foundation Permit Fee Other Permit Fee Sewer Connection Fee Water Connection Fee J TOTAL Building Inspector Div. Public Works ' sa i { ri. :O A r , MSM 0 z I e it J �a M = w J J hil H QW W LL z z Lu Z V oC J m br o •i i p p., z ;,1 Q W i z O LL i i O H J.oc 5 HIn W W J Z Q fY z IAL z w16 J i N N N W L G V a LOT 27 178.64 tel. rABLE. 53D8'1.1 "E 594'17 '4 ------- — � R-172.47: — 173.7s 11+00 =176.21 11 +50 =177.91 12+U=176:96 V C.B. N 1=167.92 WTR 173.31 10+50 =174.68 12+11.48 12+5( 713 3:14 < 13+00 =173.45 GAS 77_ 5 i0 n 173.48 _ —�� 17 57 174 _- 77 175�T - C.B� 11 � l � +-H�'flRMdT =17 EC• 177 04 1 77-55 G.V177 12 TEL TEL CBL t167.11/IN 7s, »2.as 57.011OUT .off �" p•U C. SEWER �jSPJKFSET�� SOA QQW ►T2 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ******* ******APPLICANT FILLS OUT THIS SECTION***(*****`****************** APPLICANT �hn� � r� 'c� , fY)� f�y;n�r„5 PHONES J I //5 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREETS l IZc1. ST. NUMBER ******* OFFICIAL USE ONLY *************** TOWN AGENTS: CONSERVATION ADMINIS RATOR COMMENTS "TOWN PLANNER COMMENTS DATE APPROVED _ DATE REJECTED_ DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE %L ty. I Date 1 I Number page i s I , To: I r I Rhone i Fax Pho �c J cc; i i Stj i mm i n a Poo 1 Cent. er &(M^ 509GS50711 P-01 i, W IM MING POOL CENTER, INC,. 00 SOUT$ UNION ST,` - 11i LAWRENCE, kO1843 ; Phonc 1, (978)G82-6916 [-',',ix Phone i (978) 6&5-0711 Urgent For your rcwacry ❑ Reply AS � ❑ Please comment P eA M) I 5 1 'mv i 4)e, 1 POO 1!5 C(�5 04/28/98 12:10 TX/RX N0.9040 P.001 m zoo*j OV06*ON XH/X1 OT:ZT 86/BZ/60 LU co 9 M -M -OLS C -' R L0 VVI 'nusirwe IaOJIS LiOnin winos o JOWOO 10"d -0 -4'.4 -a 0 f orad ki, t.4 ! w w ! 1-1 S z x uo 9 M -M -OLS C -' R L0 VVI 'nusirwe IaOJIS LiOnin winos o JOWOO 10"d -0 -4'.4 -a 0 f orad ki, t.4 ! w w ! 1-1 S m COO'd 0606*ON XH/Xl OT:ZT R6/8Z/VO 00 0 .0 <1 0) 63 (a 00�0 (L co Ot x (A owz 0 F- 0" 4CZ z 0 3-7 7,; 0� LU z 0 Un -C 0 0 a, 0- z CO 4-� (-) H (f -j c In O fr-M V) ko 0 0 _j w z <E 0 )-40 w LO w (o CL J-4 0 :30 N IV 4) 41 ON 00 0 .0 <1 0) 63 (a 00�0 (L co Ot x (A owz 0 F- 0" 4CZ z 0 3-7 7,; 0� LU z 0 Un -C 0 0 a, 0- z CO 4-� (-) H (f -j c In O fr-M V) ko 0 0 _j w z <E 0 )-40 w LO w (o CL J-4 0 :30 N IV 4) 1 • vv N +�. �cz ty w LE cn 0 w w w U x C4 0 W a c�4 w W w w pG a a°' w w W cn cn 41 ml 2 0D O E CD L O Z °L CL O CO) D C I � C h Q 'O O E1mm ,co O.0 O m O d a �Q CO cc v d O CD C3 CLC V W cc c C _cts H Q c� o O CO :Z O 0 cJ q E a �• V V' C c JE 4: q;CJo cD E C� E C co y CD m y V' y C � A L I.C y y C � ry� Ogo O W m O cmO :e y O :�= Of Oc Minor �7 m xL03 j 2 Z o No. mos cm Cp a m � CO ` m C O ~ 0 y O 0 m La rte+ ♦_. LL •y O C = v Z O v C m � o . ca _ A .0N �O C b■� im O d = Aa � 0D O E CD L O Z °L CL O CO) D C I � C h Q 'O O E1mm ,co O.0 O m O d a �Q CO cc v d O CD C3 CLC V W cc c C _cts H Q Location No. r , Date 2Sel 3 9 r j TOWN OF NORTH ANDOVER Mi V,mccupancy $/it ►) + - GiZ 3' IAQW&W Permit Fee $ Foundation Permit Fee L4AN FER Z4r er Permit Fee $ Ct3f�gqY��ction Fee $ Water Oonnection Fee $ \ TOTAL $ Building Inspector Div. Public Works Location ,No. Date /.: ' • /'� - �-; " �,,%v.ao ,a TOWN OF NORTH ANDOVER p��qp p CepAide of Occupancy $ ftc,�Zwee f1�j sACMUs Foundation P� b $ n Other Permit Fee $ Agar nection Fee $ d Water ConrTecfipee $ TOTAL $ ` Building Inspector Div. Public Works Location 67 t�� No. ti Date TOWN OF NORTH ANDOVER c . C4. „ Certificate of Occupancy $ Building/Frame Permit Fee $ CMusEt 2!Wqjqn.Permit Fee $ Sewer Conned I Hie $ t k ,61) ' I j Water -Connection Fee $ x)- 6.6 lL! T4 `4 r- //$ c2U0//,y6 Build! g Inspector fax Y Div. Public Works PER111i, ri0. �' Y APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. �� .� a 1/f PAGE 1 r1l d MAP 4.46.I ZONE f LOT NO.— SUB DIV. LOT NO. 2 RECORD OF OWNERSHIP iDATE G BOOK PAGE ' I /j LOCATION l I PURPOSE OF BUILDING ,- C. OWNER'S NAME�t Tht&its 7a NO. OF STORIES SIZEf C3 e OWNER'S ADDRESS r^ ,1"6 BASEMENT OR SLAB L�'7 fes. ARCHITECT'S NAME "` BUILDER'S NAME i I_ _ •� ^jam `I,,, SIZE OF FLOOR TIMBERS 1ST te�) 2ND %Y )tel, 3RD G�V/L/ SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS f/r,�-/Lt�� .� DISTANCE FROM STREET .�- ✓ "' POSTS I/' DISTANCE FROM LOT LINES - SIDES "j'"I"`9 REAR'tj ��/ "' "' GIRDERS%,� ?� ,�'� FRONTAGE /Qe—> AREA OF LOT 2 3 HEIGHT OF FOUNDATION— THICKNESS /4'/ IS BUILDING NEW Y� SIZE OF FOOTING X IS BUILDING ADDITION 11 GS MATERIAL OF CHIMNEY .(i /: i ,O� IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND) 1� WILL BUILDING CONFORM TO REQUIREMENTS OF CODEYe IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS L NE SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 12 INSTRUCTIONS M ME DUE FRAME PERMIT $�® ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS - r PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR � n DATE FILED SI OR AUTHDflZED AGENT FEE /,0 PERMIT GRANTED +! 141992 OWNER TEL. # ck -S COWR. TEL. # C0NTR. LIC. # 3 PROPERTY INFORMATION LAND COST 9 s- , eJo'e e9b, EST. BLDG. COST 0 CSI 6 V--),V-Q.7 EST. BLDG. COST PER/SQ.. FT. ��r � EST. BLDG. COST PER ROOM j 26 cZ> SEPTIC PERMIT NO. N /I 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN / � t BUILDING INSPECTOR BUILDING RECORD OCCUPANCY 12 a SINGLE FAMILY" SiOkIES MULTI. FAMILY —� OfFf.CE$ APARTMENTS __ CONSTRUCTION 2 FOUNDATION ' 8 INTERIOR FINISH CONCRETE 3 1_ 2 -13 .. _ CONCRETE BL'K. _ PINE BRICK OR STONE HARDW D PIERS PLASTERS DRY WALL UNFIN. 3 BASEMENT, I �, AREA FULL 4 FIN. B'M'T' AREA _ '/. FIN. ATTIC AREA NO B M'T HEAD ROOM FIRE PLACES - MODERN KITCHEN 4 WALLS I ' 9 FLOORS CLAPBOARDS B 1 — 2 3 _ _ _ DROP SIDING WOOD SHINGLES CONCRETE 'EARTH ASPHALT SIDING ASBESTOS SIDING _ HARDN✓'D COMIAGN ASPH. TILE VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME 'A _ BRICK ON -MASONRY BRICK ON FRAME, ATTIC STRS. 8 FLOOR _ CONC. OR CINDER BLK. WIRING STONE -ON FAASONRY.• STONE ON FRAMES SUPERIOR I POOR I _ ADEQUATE l NONE -5 ROOF GABLE I HIP GAMBRELMANSARD FLAT -SH ED 10 PLUMBING BATH 13 FIX.) TOILET RM. (2 FIX.) WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL ROLL ROOFING STALL SHOWER MODERN FIXTURES_ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBEQ OLS. STEAM STEEL BMS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS OIL THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS36F1. BUILDINGS. "WITH `16ORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. C. 7 F ' 7 NO. OF ROOMS � B'M'T 2nd � ELECTRIC 1st It 13r 11 d I NO HEATING Y FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** i� II _ APPLICANT: Tl -\h Mcks -De 7r . k f A�Lo Phone LOCATION: Assessor's Map Number -Ji Parcel Subdivision 14 1 � /�//) Lots) , Street f t,iri' �i 0 , y�i�� St . Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: � ') Date Approved 11�115 Conservation Administrator Date Rejected Comments Town 'Planner Comments Date Approved��-- Date Rejected, Healt /f Date Approved CT//Z / h Agent Date Rejected Comments Public Works - sewer/water connectionsp - driveway permit ( C.Y✓�.�1 r/ .f c� o� o,c,rn�.►1 13��cnj�L VF Fire Department �� Received ---by Building Inspector Date t F S IT -E pl.M OF L. ND N6. A1�DOVR, M� AIS l p• -cc LoT L o -r 3 DEC 14 1992 Pcza�fl Z3 � I Pocz�K -1 y � ' 'oQ00, Ron Lov2- I(15(a2i 7. 2 5 1CERTIFIED FOUNDA TION PLAN I LOCATED IN I SCALE:1". 4-ol DATE i 93 Scott L. Gi/es R. L. S. 50 Deer Meadow Road North Andover, Mass. I / CERT/FY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BY LAWS OF \o, p Nrc, K4, WHEN BUIL T. L OFFSETS SHOWN ARE FOR THE USE OF THE SU/L DING /NSPEC TOR ONL Y AND SUCH USE /S FOR THE DETERMINATION OF ZONING CONFORMITY OR NON- CONFORM/TY WHEN CONSTRUCTED. E- ..f 5Zn „�% t1-lg'�) r, y L�j uj w z Cd c Q� � Z 4 •i . a 79 l��. L .� D �RE _ s .5 m cc cLN G = s 44 G r.+ o0 C3 m VN cag CD m� c C' 3 h r: m r m W cv L: y m > ya c, y O cc �. c o. o CD `COIN O G C* ev W c r�Z mmc•�-. .y �0.=- O G .y V .O p CD !E CD C VD a m =o 'a = A = v H= F- s .$ 06.9... m m CLH Z y O i y C 0 IM m rm �o m 0 cm C �C N CDz 0 Z O g 0 5 IN y o. S J z LL y O co L Q C O Q 0 Q r., CO) O O Q .Q CO) C O V 0 CD Q Q Q O C' = �a � C O Ca J .� O O zQ Q CO2 C p w° a cn ° w a w° a U is Q w ° w a cu° is w � w W t > V cn in G w x p O a: is G w z w w G co 6 z cn Q p cn y L�j uj w z Cd c Q� � Z 4 •i . a 79 l��. L .� D �RE _ s .5 m cc cLN G = s 44 G r.+ o0 C3 m VN cag CD m� c C' 3 h r: m r m W cv L: y m > ya c, y O cc �. c o. o CD `COIN O G C* ev W c r�Z mmc•�-. .y �0.=- O G .y V .O p CD !E CD C VD a m =o 'a = A = v H= F- s .$ 06.9... m m CLH Z y O i y C 0 IM m rm �o m 0 cm C �C N CDz 0 Z O g 0 5 IN y o. S J z LL y O co L Q C O Q 0 Q r., CO) O O Q .Q CO) C O V 0 CD Q Q Q O C' = �a � C O Ca J .� O O zQ Q CO2 C 0 z 0 H- z � � � w o O U z �A W� � Ca �o 4-3 � � 3 a �a va � W U H � H rA >4. 00 O H H Vi CA A 0 Oa `i' L7 ~ Ow Z A U as w O W HO W W Ilk CaP LB uj 6 z 1w - 43 C C5 Cd cc CM3 *4 7g It v C's 76 g �E_ 0 co q 44 -- 0 4; d* C2.,.. L3 CD CL:9 CD CD CAI.. CD Akq Elk =80 CD, 0 0 Cb W4 cco mom • 'Ccoo l g 0CO) t L- =a COD C, ze ItE •C74A .9L C!.s 9 0 CA C3 LU CCM .3 COD CL 0. 0:5 .0 C2 go= s &_:a Cgo CLO - 0 4:6 C/) 0 CA U6 0 0 MJ cm< ca o *" C cc c co co CA DQ &0 en 0 n.- So Fry (l) u �:) m - •co�'' IICJv U w -MCD u (Z 0• U� C/) U8 C2 x o E U) CaP LB uj 6 z 1w - 43 C C5 Cd cc CM3 *4 7g It v C's 76 g �E_ 0 co q 44 -- 0 4; d* C2.,.. L3 CD CL:9 CD CD CAI.. CD Akq Elk =80 CD, 0 0 Cb W4 cco mom • 'Ccoo l g 0CO) t L- =a COD C, ze ItE •C74A .9L C!.s 9 0 CA C3 LU CCM .3 COD CL 0. 0:5 .0 C2 go= s &_:a Cgo CLO - 0 4:6 C/) 0 CA U6 0 0 MJ cm< ca o *" C cc c co co CA