Loading...
HomeMy WebLinkAboutMiscellaneous - 85 JOHNSON STREET 4/30/201800 Date ..41. 1.. ��................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that VC-),-! has permission to perform ........................................................................................ wiring in the building of........ 3.P O _........................................................................................... at ......... �Q^,.� 5a.�..?1 Andover, Mass. ................ ......... .................... Fee ... ............ Lic. No3.... ............. ...............XCMASPE ELE CTOR Check # ��� I Ii3i 3 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATIOl9 Date: 15`C� l City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. fA`26;8 -)S•?6 Yes ®-No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters _ Completion of the following table may be waived by the Inspector of Wires. 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- ❑ o. of Emergency.Lighting rnd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners EIRE 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 ' ."'...r""""""..... Tons KW " No. of Self -Contained Totals:....' Detection/Alerting Devices No. of Dishwashers Space/Area Heating KWLocal ❑ Municipal El Other Connection No. of Dryers Heating Appliances ger 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 Ea uivalent 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 [BOND ❑ OTHER ❑ (Specify:) I certify, under thepains and penalties ofperjury, that the information on this application is true and complete. G FIRM NAME:y ' , 1 vl SL(�t;J ! LIC. NO.: ,O / Licensee: (If applical in the LTC. NO.: Bus. Tel. No.: l Auaress: -l' FllnECdll.JU1)U 1)7z. �H,t /;1 " � U / n L2222 I / Alt. Tel. No.: 6 03 - *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent rPERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date. - SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL WUGH INSPECTION: Pass 0 Failed 0 Re -Inspection Required ($.) ❑ Inspectors Commen : Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION PassIk Inspectors omments: Failed 0 Re= Inspection Required ($.) ❑ 6 Inspectors Signa ure: ate: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com N 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 06 L Address City/State/Zip:�M I h S On %V 114 Phone #: Are you an employer? Check the appropriate box: 1. ❑ I a employer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their K ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c.152 3 .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.❑ Electrical repairs or additions 11. El 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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Dontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. isurance Company N olicy # or Self -ins. Lic. :)b Site Address: Expiration Date: City/State/Zip: Atach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 C up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations 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. /Z Official itse only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): I. 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple 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. # 617-7274900 ext 406 or 1-877-MASSAFE .evised 5-26-05 Fax # 617-727-7749 www,mass,gov/dia IMPORTANT! Please complete the attached label and attach to your breaker box for future reference. Warmup Inc. 1-888-927-6333 Electric Radiant Floor -Warming System Date Installed:/ Fed from fuse/MCB No.�li sJln Q& del Number of Heaters:_ Amps heaters: 1 � 2 Ci 3 Installer's Name:�71E7. (n1n INSC� 1C-�''?'�� C Installed in Room(s):\, � Electric Radiant Floor Heating System Warning — Risk of Electric Shock Electric wiring and heating panels are contained below the floor. Do not penetrate floor with nails, screws or similar devices. The Electric Radiant Heating Warning Label must be placed near, or on the face of, the control. a) c 0 E O a..r C tC 1p 41 E EO t u -v E C c0 � N 3 a3 E 3 V �G O e- 0 0 V C ro V d � � U_ E u_' toc 3 nZDo '-', Vi4 f ° t M � r qg�hF �D s> N O\ M M M �D N O\ 00 00 00 IL GJ tj C N E 'n � d � aCC C a � � �� 00 3 v C '- 3 3 o.x 3� _ L6 3 z zo Ou D O Q1 iA ;G;6 Z w 5 O D 7- $A O W �. IL O u" u OD Ln CN 0 Ln ra M 0 Z Z) o :3 N � E ro (D 0 u 0 (5 - U ro 0', 0', @)ro E V) 0 ro Ln Ln " Lr) 0 C) u ro tA Acb m (a C CO 00 + +O ill V) u E Ld s, 00 E E 0 0 U D o u ct CL N N a E L cb ao AWN c co co 00 co our) C Lf) D 0 Z) O 0 r- 00 00 \�O C) F— V M M M N 00 00 00 C N m H � •IA N aC7\ N 00 9339 Date .. TOWN OF NORTH ANDOVER .� � '• °oma PERMIT FOR PLUMBING This certifies that ..a,4..J���!�+'v'.� w �7 /..✓¢ove l'� Ce is l' has permission to perform ... t .//ro. ...1` ..........�i�.. i1r�v . . plumbing in the buildings of....ef!-r"I...................... at ..../ 5... ✓.��!'�u''.. -rr.......... > , North Andover, Mass. Fee. 44 Z• Jt Lic. No.. //249 . ,Gr j/' efi�7. PLUMBING INSPECTOR Check # %DU MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERI=ORM PLUMBING WORK CITY lV 0 2'7 t,� AAAd -dE-`YL— DATE 3't Z PERMIT it ,. 40881TEADDRESS; I Sd�l1 S� r :OWNER'$NAMEJ rod 2 Rf �j OWNERADDRESS I c: N S O +l/ �1, 1 TELT 9%e02�j- /P i 1FAX� I TYPE b1 OCCUPANCY TYPE COPIIMERCIALI I EDUCATIONAL I RESIDENTIAL PRINT CLEARLY NEW., • j RENOVATIPN:I i REPLACEMENT: PLANS SUBMITTED: 'SES 1 I NOf I FIXTURES T FLOOR -4 13SM 1 2 3 4 5 S 7 ti 9 '10' 11 12 13 14 BATHTUB _I......._i .-..... _ _... CROSS CONNECTION DEVICE DEDICATED SPECIAL—WASTE—SY$TEtai ? ; .. _ - ., - •- . , , . - ..._.-_. _-:. __ DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM ; ... _ ... i .... .......... .... _._ .:...... • - . _... DEDICATED GRAY WATER SYSTEM -.._ _.... _._.. `-- - ' - DEDICATED WATER RECYCLE SY6TEtv1 - - • ' - '- - � - - DISHWASHER DRINKING FOUNTAIN l .... I ::. . FOOD DISPOSER J. I I ' , ) •:: _:_. i i ... '—:—� _ FLOQRIAREADRAJN - - i ' • ' ' � - - l ... '- ' ` . . .. - i INTERCEPTOR (INTERIOR)I ... KITCHEN SINK LAVATORY l. i. - ... ' I--- .... •: � . ROOF DRAIN _ _ - _. SHOWER STALL $ERVIOE/MOP SINK TOILET URINAL - WASHING MACHINE CONNECTION _... -- - -'- WATER HEATER ALL TYPES _ .. WATER PIPING . .OTHER I .... f r ..... _ .. _ INSURANCE COVERAGE: have a ctirrontlia!_ �ility iiisilraljee policy.or its sulistantial lequiValent which meets the regtiirenients Sof MGL *Ch.142. YES ju-�'NO ( I IF YOU CHECKED YES, PLEASE INDICATE TH YeE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ( OTHER TYPE OF INDEMNITY i BOND [• OWNER'S INSURANCE:WAIVER: f ant aware that the Iicensee..rloes not have iheTnsurance coverage required by Cfiapte042 of the Massachusetts General Laws, and that-nty signature on this pertifn application waives this regttirepten't. CHECK-ONEONLY: OWNER AGENT. - SIGNATURE OFOWNEROR AGENT 1 hereby certify that all of the details and information I have submitted oc entered re'gardiog Ibis application Wei true and accurate to th hest or my knowlddge and that all plumbing �tiorh and tnstallalions performed under Ibe permit issued for this application %A1 be in r ory (S�arice t ' it Pddi t pr A' oT the Massachusetts State 'Piumbing Code and Chaplet 142 of the General Laws. U( PLUMBER'S NAME[ 11-ICENSE 1! l //1/0' ( SIGNATURE MP j w- JP I CORPORATION J .111! PARTNERSHIP( 1111LLC 19 COMPANY NAME PRL 0/Ur-le PL6 s: 4-76 ADDRESS[ 7Of% ! •. CITY STATE I ZIP !ELI 663 FAX CELL] EMAIL. t� w � Q CL A400 a � v ra. Q of xt a �;f'ftcC'pjlijio1![ue[..t�tlr ti,11t(rcir)`i�Efeytf y .� =� A2ft{rx7itx2ir�n� ff3EtTtts��ttrl•El�ei(��t{fs fil%ic o`Xrit�esfii{tialr� r 6rsttlrigfoirYt4�f yt Vvu; IWA!' (2HI vorwit i�rQ1EC1'S CQlltTltil5tttk0i['il�lCi�n11� i fidht►;f►ieiErfn�•cr(tii.�.••.� KIP, I Ztii�(13x11'u,Ic��'Ut iniiitmnrJlWi4duat ' llr��olrTtireitljtTo��cl•2G'tlecTsitle�tjZltoln•Ftlteblir•: - ; � • j�s0'�;�f�tl'o,[etE�et�,t[ie�ij; 1:©t.tta�ileintttb�czt�itii �. . ,- - �f. [� (i aninge[leenlcoillydctprtltit�1 «iltta�ccs�fid{n«ctrocp�ttiiilic) [[aeetlirc<Fii[esub�coriirnclors �� p�-���c�4��iis{iiiciion �, -,tRuttlsolelltvprictororttnt�«cr.- Iistetf8liii'iettt{�FFtecls��g�t.g �� [1.�1�CilloIFCF11Ig sjiipRlul[tttt�enoctnpio cos Gasl`I rccslrt;ofiifcaitre tldi'Cfliituil f,] Us "iltU•coii(roetdrslFata I7elitoF{l{oi1 egotii[ig.foliu fitOnyCnl�ttcil}t. a tepi ct��colilp•. jnstn [icti �soi�:er,'conl}t.iasiuT110 , �: [7 � eiirZ R cU[ZIOraIrp gild 11T �: []'�liiiitlFngtittllitiolti r;gittlltj .nI;itnlatiatlieouliertioil>gli1(iKotfi ofticersLndgccrcgsecl{lieir r%�fifofc�eauptiolt et`MGL tp;�.`I's[eclric(Iltzltllit�-orndditiotis: 1; . �Ttf[11UL1R�It'�11ir�QCtlltiil[1011`: tll3seif[�ta�tibrkcrs'cotu�. Ftisurnttcdtcquiretl�� ,iA2,aF(,1),Outtoitaveilo - 1rliij?foj't:tss. [Nrzivorltices`' f : npofrepllils - - c4111p,,{nsura«cceenntretT.}. 1�,�0(Tler . - - bidiallip.& lacy lrilydtuiErrl%lvlrctcllirr[isiicvtrPrlft>b►R�vlTet's'cvlitf�citlsnlio[liltsurRticefb�/1{I't'11�I�►ees j3ejdllrls!(I�Erel1[et"ntrrifvGsif4• /i�aF/It[t(iQll. blifiralico compaf ly'Raft P01103,fEorSc 3=itls.Lic.fk Y t '3,Gsji%atitilt lliiter 1Lt(nclta cop ttit'(liCttaittCl$'eoiuJielisR (oix�to]i�; }le ittt'RtiptrT�ft rx(sx(tllttt tl[`eYloTtcfiFlll11tUEr:(illt.Oxf;tuatioi[itnfe): aifttrc(aso�u[e�dtentg�irslet)utPzcltntiterSectiali�l5holMCif fp{FRstitens ct ii�F52cmt(ti(loll fcilillint ttiCsstla yertalties. in the forret ofll STUP:II'Q2Zt� Ojtb�[t iinil.1:�illc lifupfa$250.p0nday'R�t[nlsttttFvioF7[ol•. !tr*Rdtisc<ttllatilcopy�bf(Fuss[alEmeritiully�6zfolii%artelllo{h�Offfceo£ loves['�va7ions:o�tfieDlli`['orittsumticeca�eroget'erifieatio«: - - - ---- - - - 14,z(rer eSj! i? • rrrlrlc�IT,e prltus 3f:6/72 - a tlilr`��5c'(11r�1: jlannE[rir`refrrtilisruerr,to faint. oy zetdr: 2- Gitj�ol•laii�ttt : ; .i'e1�7i[Tf(f;(eet_[seif •Ts�tiF[i�lYtittiori(�t:(cii'c[eoi[ej; li.09t110(tort-1c.11th 2,1ruitdingUcglrrti«I1tE 3.Git4fiol+iiCic%t .Clgc{rtsn l[tsttc+`(oi= I'1[tt[[Gingitts}}c {o1? 1x. Q11ret - 51 n Date....... a......`.. ..... AORTh 0- TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. 1/ .... �Z- ................. has permission to perform ............ .......................................... wiring in the building of ........... at ............ -5..; ................... . /,�orth Andover, Mass. Fee .35:-79— Lic. No. !Y54.3�.......... BLE Z*ICAL-I'N-S'P*EC*r*0R" Check # 10725 b -f6- Wad fastrait -o ma s..Plwp qq v g-6nro&ejrOnIA M, MIMI', ted 0'r, 1.40 4ttaleso cIiV�Ili4g Boas 10 rtIlt; PCOUP, Ilt. of file 11 SIMofritiotlier w7lb, 6illplb31s persw f6kiiiahiten citt�IliitgTioiise parlal-Ifto pff eull)cto a bl bluldings la the I Or, eeati ozi TerE Ac I eo �c6orco 0 ties ea 2, 1, bl 1 Rib al ly 3f 1, - .7 `141 in C OM 0 cce a .011-. t or, I -,8flco fp ibli elnen S mIll c1t t .0 s I till fligApjty (q6.1ii sill tioll Col 0 1 Ifallilcor'LLP does have A%fsb baspre.' be refurfledco fits elly or tolvn Plat flit application for the pel-Bllt or licensci i's belma- requ., sted, not-MeDc, tiffinicat tof he f0the-pumbeflis , A idd b--IOSY. CRY or Toiqt OiricmTs 0 YO t fLtd Pleasab.cisuro(offif a f j nt i s t s A i I I I j , I C11)l f,-, p an i Pdl 0 11 S e -.1pp) ic a I f0i Pblicy In fonnatikon (ifyie.ce-wAty) Paid-luldet "Sol) M!vAd(TraSP he by tho.elly or tOlvil Ditty be-providud fa Ilia tillplicanta's pro ckfthaf a vaf rd iffditiq jj6' officemps. A liely-ALMavit lillisf,fie filled out each veil il7ierai fi ft I 6.-fd r -f g. a 16126 Oklltrliiit not related foonSebusilless Orcoffillier,cial Vdntuke ((:E a <To�,license ar perntitfo burn leaves etch saiit persoltis NQI'rzquiracl tq collilileteftus affidlzzf, TPA. 0617-y27-4poD ggc4o C'ommonwea(lJr. o` a�ac alfa Official Use Only cc��rr�� cc77 Permit No. l d 7 Z.,� 11aPart►nanf o�,.ti•'ra �awica! BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. I/07] leave blank APPLICIATIONwork to be peFORrformed i PErRMIT TO PERdance with the IFORM ELECTRICAL WORK e WE ), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: _ �z_I1 Z_ CRY or Town of. 14,4ZDe%,Z To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) .� Owner or Tenant _ �o�'�? j Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 2— No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps _ / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followin table m be waived b the Ins ector o Wires. of Recessed Luminaires �oZAKi No. of Ceil.-Susp. (Paddle) Fans —0.—OT Total of Luminaire Outlets �— [No. No.. of Hot Tubs Transformers KVA Generators KVA of Luminaires Swimming Pool A ove ❑ n- ❑ o. o mergency rg ing rnd. rnd. Batte Units No. of Receptacle Outlets No. of Ott Burners FIRE ALARMS. No. of Zones No, of Switches No. of Gas Burners o. o etecbon an No. of Ranges No. of Air Cond. Total Tons Initiatina Devices No. of Alerting Devices No. of Waste Disposers Dis p eat Pump um er ons w Totals: -- ---- '�" o. o e - onta ne Detection/Alervinje Devices No. of Dishwashers Space/Area Heating KW Local un cipal Connection ❑ Other No. of Dryers No. Heating Appliances KW ecunty Systems:* No. Devices of W ater Heaters KW °' ° °• ° of or E uivalent Data Wiring: No. Hydromassage Bathtubs Signs Ballasts No. of Motors Total HP No. of Devices or Equi—lent 1 a ecommunications Nviring: OTHER: No. of Devices or E uivalent nuucn uumitonat await y desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Stan: 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 ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enalties o rl ry, p ) p _ jpe u that the information on 'app a ' n is true and complete. FIRM NAME: I�i�41 10 CLECTRI C.A L otciz'RAiC, g -i LIC. NO.: Licensee: t>AV to 4A66AR, Signature 9 103A (If opplicable enter "exempt " in the license number line.) LIC. NO.: Address: 87 ��.1Y1t7N'I° �r Ni7RPi IluUflt(�Q tNi� 16�l� Bus. Tel. No.:q78 -2,. 62G,� 'Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety S License: Alt Lie No. �i �B•�-y 73q 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 EJ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 1 qa-4� zf-,� 0 - 2� �t12 L( I The Commonwealth of Massachusetts Print Form I D2 Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 W_ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 87 BELMONT ST DAVID ELECTRICAL CONTRACTING LLC /State/Zip: NORTH ANDOVER, MA. 01845 Phone #: 978-682-6262 Are you an employer? Check the appropriate box: 1.0 I am a employer with 7 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 These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp• insuranceJ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' coma. insurance reauired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.✓❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: THE HARTFORD Policy # or Self -ins. Lic. #: 08 WEC C18293 Expiration Date: MARCH 1, 2013 Job Site Address:City/State/Zip: 1,10ew ,� Ci /moi 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 forAsurance coverage verification. I do 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 #• 34 17 Date. ./�....`.......`..... NORTH TOWN OF NORTH ANDOVER py .io ,•1�OL p PERMIT FOR GAS INSTALLATION ^ s s This certifies that .... �.�.� has permission for gas installation .. .A-. ` ... �. `..` `.:...`. . in the buildings of .... !...:.1 ............................. at .. 1....: ............ North Andover, Mass. Fee.. Lic. No..,/G.?:... ......:.....�::... * � .... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MIN 4ASSACHLTSE17S UNIFORM APPUCATON FOR PERMIT TO DO GAS FT MNG or print) MASSACHUSETTS Building Locations no Owner's Name New Renovadon Replacement Plans Submitted Date ._) /—.�.._w._ (,ry lo w IPf.�w� wnww,wwr Permit ti: 3 3Y/2 r� Amount $ 70 �.. (Print or type) Iff one: Certificate Installing Company Name Galinsky-Pl.wnbing & Heating Inc, Corp..1 95- P.O.Box 1701 Haverhill, MA 01831 Address � Partner. Business Telephone 97,9-37T-1743 Firm/Co. Name of Licensed Plumber or Gas Fitter Ste hn C Calinsky INSURANCE COVERAGE Check� ED 1 have a current liability Insurance policy or it's substantial equivalent. Yes L�f..J NOM If you have checked v s, please indicate the type coverage by checking the appropriate box. Liabiliq, insurance policy 0] Other type of indemnity, Q Bond 0 Owner's Insurance Waiver: I. am amarc that the licensee doe g2t havg the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my siananire on this permit application waives this requirement. Check one: Signature of Owtier or Owner's Agent Owner � Agent hereby rettifi, that alt of file details and information 1 have submitted {or entered) in above application are true and accurate tot e bgst of my knowledge and that all plumbing work and installations performed under compliance with all pertinent provisions of the Massachusetts State Gas CodejVd C Title fCity/Town t JAPPROVED (OFFICE USE ONLY,) Signature of Plumber r Master Journeyman U tJ � � as C: G +"W w L i C7 � GL 2 I+ C SSU8-BASE,M C N T 0A SEM ENT IST. F L 0 0 R '}N D. FL0011 I 3RD. F L 0 o R STH. FL00R 61'11. FL,OOIt 717 ft. F L 0 0 R R'rEf. Ft,f?0 R (Print or type) Iff one: Certificate Installing Company Name Galinsky-Pl.wnbing & Heating Inc, Corp..1 95- P.O.Box 1701 Haverhill, MA 01831 Address � Partner. Business Telephone 97,9-37T-1743 Firm/Co. Name of Licensed Plumber or Gas Fitter Ste hn C Calinsky INSURANCE COVERAGE Check� ED 1 have a current liability Insurance policy or it's substantial equivalent. Yes L�f..J NOM If you have checked v s, please indicate the type coverage by checking the appropriate box. Liabiliq, insurance policy 0] Other type of indemnity, Q Bond 0 Owner's Insurance Waiver: I. am amarc that the licensee doe g2t havg the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my siananire on this permit application waives this requirement. Check one: Signature of Owtier or Owner's Agent Owner � Agent hereby rettifi, that alt of file details and information 1 have submitted {or entered) in above application are true and accurate tot e bgst of my knowledge and that all plumbing work and installations performed under compliance with all pertinent provisions of the Massachusetts State Gas CodejVd C Title fCity/Town t JAPPROVED (OFFICE USE ONLY,) Plumber Or Gas Fitter !cense I uttt t' appttcation win oe to .Tal Laws. Signature of Plumber Gas Fitter Master Journeyman Plumber Or Gas Fitter !cense I uttt t' appttcation win oe to .Tal Laws. r Date.& — --,? f- (I '-) N2 /- 7 4. 0 .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ....... . ............ ........................ has permission to perform ....... .............................................. JJ wiring in the building of .... .................. ............................................................. at... ........... ; ............ ..................... . North Andover, Mass. Fee...... Lic. ............................ e ................................... ELECTRICAL INSPECTOR Check # -41" WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1t1G'(UMMUIVWL'r4LIHU!'�11�9(H(/.SL'"Ill —office Ilse only ---- DEPARTMENTOFPUBLIC&I[MY Permit No. _c-,%410 BOARD OFMEPREYEWONRWMTIOAS527CMR I2 QD Occupancy &Fees Checked 41W APPUCATTONFOR PERMIT TO PEUORMELE=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) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perfi)rm the electrical work described below. Location (Street & Number) -q S j„ 1,/,r / S A „ / V� — Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes - No (Check Appropriate Box) a _- � Purpose of Building 5tA16I S "/6 fllzs r .41, Utility Authorization No..,` Existing Service Amps / Volts Overhead 1:3 Underground No. of Meters New Service- Amps / " 6 Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work LAX l -/ l t G cf Gs 1l Ly i �i[L; No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlel No. of Switch Outlets No. of Ranges No. of Disposals 1 No. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro Massage Tubs OTHER No. of Hot Tubs Swimming Pool Above ground No. of Oil Burners No. of Gas Burners No. of Air Cond. Total Ton: No. of Heat Total Pumps Tons Space Area Heating Heating Devices W I No. of No. of Motors No. of Bailasis rotal HP No. of Transformers Total KVA Below Generators KVA ound No. of Emergency Lighting Battery Units FIRE ALARMS No. of Zones _ I otal No. of Detection and KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Municipal[7Other Connections hUarreQMrega RMatiDthetag MMUISdkbmdxmgsGmrALaws Ihaw aa.etentLiabtliyhuarnPbbytrtc]udmgaxnpkk0Er1 t>SCatdWcr sskkWtdq valla YES F1 NO Ihaveahni&dNeWproofofsam lothe0ffiop- YES M NO r7 If}whaedidWYES,pkmemdi *theWofamrd ebydedaigthe NSURANU M BOND 011[ R M ftmSp ify) WakIDSW lnspectionDakReWesW Signed undffTie %mities ofpejwy. FIRM NAME —!114 4t Al d-,4 w1 i': 0&1 a- ) . X -M �� EViraticn Date Eshm&dValmdUechical Wait $ Fel sr q CCSn c y�2 i C LiomseNa J U/ LicenseNb? Bmirx%Tel.Na Addr�c 1 ' A ! V { &Ao � � ✓!i/'� AIL Tel Na ! q -U � OWNER'S INSURANCE WAIVER,Iamawmethattheticamdoes�thei<tstaatoeot�,aa�aitssl>la it asreq�edby C, {L and d"ggnaftmonts p=nitsppficMon wain this rwp'kenalt, (Please check one) Owner Agent 0 Telephone No. PERMIT FEE $ N2 2 7 2 Or Date. & TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................... : ........ : ................................. has permission to perform....................................................... ;7�-.;.' ............. wiring in the building of ...... .............................'..............C.........:..at�u ............. ............................ North Andover, Mass. Fee .........Lic. No. ..............."—1.1.1.:11...'...........................— . 171 -1' ELECTRICAL INSPECTORCheck # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer JIM (,U9T UJVWPALIH UP M4NM(.HUSL'17N Office Use only DEPARTMENTOFPUBLIMFETY Permit No. BOARD OF FIRE PREYEWONRW ULATIOAN 527 CMR l2: �D Occupancy & Fees Checked�� APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) 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) 9-5-I JU A. --IS O A �T Owner or Tenant 7 G A 777, Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building / G1�/ 1 �/ G� Utility Authorization No. Existing Service Amps Volts Overhead ID Underground a No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above El Below Generators KVA KVA and ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumers FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP i OTHER IrstcanoeaKrage RffSU nttatheroglZat%dNbNx1�GenaWLam Iha%eaamerdLabilkyhstrancePbbcya dL&garrpiete Omafm catragecrits stksbv is alug ala# YES NO Ihaw submidedvalidptoofofsametotheOlTKr- YES M NO� If}uuhirwdmdWYES, pkmbdc*thetypeofamWbyd=kngthe INSURANCE [D' BOND r7 OIT-&R (PieaseSpecdY) Work ai Start �/ Z Signed Lnder r l'"Il e FIRM NAME 5-V I EVi Date G G Es Valw f E6cftica] Wait $ `704 . o`r� InspeMonDalleRapestedFibal tion OWNER'SINSURANCEWAIVER;IammatethattheLxesedmnut the mddutmyssgiakjR-ont m pmmtappficmm wrai%Aes (his mgt'snem (Please check one) Owner M Agent 0 L=WNTa v 49 _ Lio sellllo �- BmirtessTeL Na try Alt. TeL No. as mquiW byMasachtseus Gataal Laws Telephone No. PERMIT FEES Date .... �/.... 3.....1-..7.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......................................................�— ` has permission to perform .......... .. 1�/` ` .. wiring in the building of ........ .......... at .. �c ',Z .. ? ..........$. .................. . North Andover, Mass. Fee... .5..:........ Lic. No.�! ...� ...............��. ...................;:..... . ELECTRICALINSPECGbR Check # // t 3 % Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No.u,p BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev, 1/071 l.Ve 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: // - 3 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant ,�- z �i-y C /r e w ' Telephone No. U ' wner s Address S �� Is this permit in conjunction with a building permit? Purpose of Building Existing Service Ze161 Amps /ZL / Z ya Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Yes ❑ "No heck Appropriate Box) Utility Authorization No. Overhead ❑' ndgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters / No. of Meters Cum let'toh !l No. of Recessed Luminaires n o t e o oxtn No. of Ceil: Susp. (Paddle) Fans table ma oe watvea by the inspector n Wires. W0.01 ota Transformers KVA No. of Luminaire Outlets No, of Hot Tubs Generators KVA of Luminaires AboNo. ❑ n- ❑ Swimming Pool o. o cy Lighting d rnd. rnd, Batter Units Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. oDetection an Initiating -Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat u Totals: umber FortsKWo. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Nil'unicipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systeinsif of Devices Equivalent No. of WaterofNo. or Heaters KW o. Data Wiring: Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: 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: r/ 3 _o i 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 OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: 1�_ yy 33 Licensee: /% Signature LIC. NO.: (Ifapplicubl, ,n �r "exempt " in the license number line.) � 7 y- 9 3 3 Address: t Bus. Te]. No.: /.P-� - Alt. Tei. No.: *Per M.G.L c.-14'7, s. 5 -61, security work requires Departm 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/Agent owner ❑ owner's agent. Signature Telephone No. L PERMIT FEE: $ 04 N0 0 �h O M LL �s3,%c us CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH. ANDOVER Building Permit Number '/D Date — /4"t;00/ THIS CERTIFIES THAT THE BUILDING LOCATED ON 8.5— .% �" b O N 8 +' MAY BE OCCUPIED AS V!N 1e- TAAAI / /ft As IN ACCORDANCE WITH THE PROVISIONS OF THEMASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. °f )POO)" 3.- *2.CQA7•h$j .9 3-7 a// .4?&P-,4r 01 CERTIFICATE ISSUED �'O ,4 R X 7?e 11 ADDRESS �S �%O LJ S 0 I S T e�^ Building Inspector ct a z O { cz I ct a z zm- R: c •..- O N O W v: �0.2 ►�►co CCL 0 r.� O m e: cs �mm a 4i lip y m O L y y C C O O ECD to v ® o' O.c (� y �• O•E9Z O Q1 0 C C c ®%Q6 LU .� •ca W E v= &.y O L.1 m A O C y CL m��� _ cc % 0 a _O F- a CL..- C13 ? �Vv y y .E CD CD V1 y V H C 0 V ,c cc CA L ts H CO c m � 0 crW W crw U) Zw 42 ` qW� �I O C u 1�.1 O rX `� A 0CL7., m /^r�.i W t�0 v t:; m X v H o co cn cn zm- R: c •..- O N O W v: �0.2 ►�►co CCL 0 r.� O m e: cs �mm a 4i lip y m O L y y C C O O ECD to v ® o' O.c (� y �• O•E9Z O Q1 0 C C c ®%Q6 LU .� •ca W E v= &.y O L.1 m A O C y CL m��� _ cc % 0 a _O F- a CL..- C13 ? �Vv y y .E CD CD V1 y V H C 0 V ,c cc CA L ts H CO c m � 0 crW W crw U) Location (9, ,Im/I/VS0A) S No. Date ©3 _OO TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check # 1337 H $ OBuilding Inspector I: N CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE:1 "=40' DATE: 9/5/2000 Scott L. Giles R. P. L. S. Frank. S. Giles 50 Deer Meadow Road NOTE: THE ZONING DIST. IS R-3. North Andover, Mass. �O titi so PARCEL 'B" N #6452 N. E. R. D. 25,074 S.F. I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BYLAWS OF NORTH ANDOVER WHEN BUILT OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. 'ex 13872 LANG Na '254-3 Date.�l.'......I`�. r/ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... �-. `. �:':��..k:�.....? ��f �l has permission to perform t'� �� � ................:.............................................................. wiring in the building of .......fir` ................. /' ........ u r ki! .......! ................. at ......... i' t t � ..... ... .. �.,.....L............. ... , rth Andover, Mass. ............... ... Fee.. OC/ ee...00/ o....... Lic. N Check # 1.�.........'-. � °�. ..... 'ELECTRICAL INS' LECTRICALINSPfECTOR .. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer AEC0AW0r4LTH0FAf4JSOffice U seMl y DEPARTMENTOFPUBLICSAFBTY Permit No. `JC BOARD 0FMEPREVLM70NRWMT10NS5270fR 12.00 0+� Occupancy & Fees Checked i' APPLICATIONFOR PERWTO ]PERFORMELE1..11.,.CAL 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)Date edo Town of North Andover To the Insp or of Wires: The undersigned applies for a permit to perform th�lectrical work described below. Location (Street & Number) ? I � , G UV5(7" Owner or Tenant t5r Owner's Address l075- 7—t1,ePvP1 R -,r S r Is this permit in conjunction with a building permit: (� Yes E] No (Check Appropriate Box) Purpose of Building �/�'� %� S F L,// Utility Authorization No. Existing Service Amps Volts Overhead 'Underground No. of Meters New Service%%1 Ampiolts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA andground 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 LocalMunicipal 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 • :.;:- •.- ..� - • ;�. • •, a as :•. i • nr.. . �.. •r r • i • ir• 9. • . • • :• aVill WWI MM a r.: .y• a c; -.• X11 .•ra •. •:.a ��. Wcak to Sut hpectimD*Rqg Signed urdxTr RMIties of*w..� � FIRM NAME d , yyii"�- tvammuge F VahrdEkarical Wak $ Ra>gh Feral --r-1 Liom9eNo YJ 21� ,�j/�Busctess Tel Na Arlrirsr_�..-( �� `✓ //tel �/ .Ya, ' `� %/�/5Y r AILTelNia �J � OWNER'SIPIZSUR EWANER;Iamawar<etlnttheLx=doM not$teirtsxanoeoo► orAss> egtrivaler¢asragtmt�dby settSGenaalLaws aod�atmys�taernthspem�atthis Iegtotgrl�. (Please check one) Owner ® Agent Telephone No. PERMIT FEE No 1.� )- Date. ? .-..�/. -..`. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . /.... ................. . has permission to perform .... ...I-/ (-. / .`...t .......... plumbing in the buildings of ..... ...................... at. ?" s. -....J L. `.....s . `.. ........ r., North Andover, Mass. r , Fee.'V � C ... Lic. No../.� 1 t�.! .........) ....... PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR �,pe or print) Building Looatil (L-rA PVb-a� Owner's Name'` New [a Renovation 13 Replacement FIXTU"RES Plans Submitted DO PLUMBING Date . 1 2-0 —oJ Permit # �� ��•,r, Amount (Print or type) Check one: Certificate Installing Company Name G as 1 i n y P-1 u In b in& & 14;. n��� XX Corp, Address jP.�, 0.Bo x 1701 MA (� J Q Q Q j pier ny p^ h�j jndYairwlarrre.�Yid �i�.�.���rr�rr�� Business Telephone g..Z.$��t.�..7 Finn/Co. Name of Licensed Plumber: Stephen C. G a l i n s k y Insurance Covera e: Indicate the type of insurance coverage by choking the appropriate box: Liability insurance policy® Other type of indemnity ® Bond11 InLgW2; Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three Insurance Signature IOwner 11 I hereby certify that all of the details and information I have submitted (or ent best of my knowledge and that all plumbing work and installati s pe compliance with all pertinent provisions of the Massachusetts to P f By: %Ttature of ME ea Pluning! Type of Plumbing License Title Agent 0 in above application are true and accurate to the r Permit issued for this application will be in ^and Chanter 142 of the General Laws. City/Town%h%s Master O Journeyman APPROVED (OFFICE USE ONLY Town og Department North Andover Buillin D 27 Charles Street North Andover, Massachusetts 01845 (978)688-9545 Fax(978)688-9542 ADDRESS LOT NUMBER DATE REQUEST DATE READY R .rL / — / INSPECTION 9— /.,)— ION c�`1tLao ,4''NO\ 'pA �OLNIt Mt WKw V �9SSACHUS*. ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING LA CONSERVATION _ DATE PLANNING DATE �} D.P.W. — WATE' METER DATE leel) i D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN IINSTALLED Location +°��5 0/%) 5 No. "T oo Date 00-8-00 NORTp TOWN OF NORTH ANDOVER OL D i • V Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 7 ff L� 60 Building Inspector s TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �rz`l'^r 4 �i.'w2 's ,a�kr�, 40' 11�''M sF.h: " +S BUILDING PERMIT NUMBER: J DATE ISSUED: 9-3-00 -3,00 SIGNATURE: of Bindings Date I SECTION 1- SITE INFORMATION [ - 1.1 Property Address- 1.2 Assessors Map and Parcel Number: RS" �0�,'S' s A- -� 9 6 Name (Print) Address for Service w Telephone Map Number Parcel Number V� r (� eft 1.3 Zoning Information: Name frint 1.4 Property Dimensions: for Service: � as'e)y f 5;n Si nature rile Zonm strict Fr o se SECTION 3 - CONSTRUCTION SERVICES _ Lot ea Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required, Provided 77z�� rn n���vs� s--:� 36 • M j 5!0 1.8 Sewerage Disposal System: 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 of Record jOw�neer �/ / a A4 Name (Print) Address for Service Signature Telephone ;r� 2.2 Owner of Record: eft Name frint Address for Service: � Si nature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ k t KN f? _ Lic s onstr�ttction Sup'ervtsor: Q ` j 97 77z�� rn n���vs� s--:� � n, - - n n � License Number �C Address y�-� Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone IL A`_y SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... No ....... SECTION 5 Description of Proposed Work check all applicable) New Construction A Existing Building ❑ Repair(s) ❑ TAlterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: t1 q' RCOM - 6;? IL ►�, 1 "3 Isla I l Jrrft (��c� C�a V --a Y`� VVtV L » A)�� AO �s k1l� �3 ��n, �f- Ll �ct mss) -�-� SF,CTION 6 - F.STTMATF.D CnNfiTR1TCT1nN C(1CTfi Item Estimated Cost (Dollaf) to beUI Completed b permit'applicant ICIAI; USE ONLY, > ' 1. Building (a) Building Permit Fee Multi lier SA 6:1 ` 2 Electrical p (b) Estimated Total Cost of Construction 22�-- c�©� pp0 r 3 Plumbing &00 Building Permit fee (a) X (b) ©t ' 4 Mechanical(HVAC)U 5 Fire Protection 6 Total 1+2+3+4+5 Check Number 3r,%- I JAJII I a U W 11 EIM AU I HUI(1L.A 11"^ 1 U ISE UUMFLL' I ED W HLA IN OWNERS AGENT OR PONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize -' � .Z to act on My behalf, in all matters relati work authorized by this building permit application. / Si tatur o Owner Date SECTION 7b OWNERAtTHORIZED AGENT DECLARATION 1, / I/y �l r f= . as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief s MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.0 ' Checked by/Date CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 7-19-2000 DATE OF PLANS: TITLE: PROJECT INFORMATION: Johnson Street COMPANY INFORMATION: Marl Rae COMPLIANCE: PASSES Required UA = 515 Your Home = 484 Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1813 38.0 0.0 54 WALLS: Wood Frame, 16" O.C. 2609 15.0 3.0 174 GLAZING: Windows or Doors 426 0.350 149 DOORS 63 0.350 22 FLOORS: Over Unconditioned Space ------------------------------------------------------------------------------- 1800 19.0 85 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 125% of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print = am a homeowner perrorming all WOrK myselT. I am a sole proprietor and have no one working in any capacity F7I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone #: Insurance Co. Policy # Company name: Address City Phone #: Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and Print 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' ❑Check if immediate response is required Building Dept Contact person: Phone FORM WORKMAN'S COMPENSATION ❑ Building Dept ❑ Licensing Board ❑ Selectman's Office ❑ Health Department ❑ Other Massachusetts Lin. ra Y Code � i -+H F M STATE: Massachusett CONSTRUCTION TYPE: 1 or 2 family. detached DATE: 7-19-2000 PROJECT INFORMATION Marl Rae r1'1.fr-:T T.. Mf; U . _ :. Reauired UA e 515 A u A Area or Insul Sheath GlazinafDoor -_s=__----_--®-------------------------------------a__----___-_--- =r ^c ., WALLS: Wood Frame, 15" O.C. 2609 15.0 3.0 174 F T A�-: ATf,, T.Ti-_-.-,,.---, - ice-..-.-.-. - = sa.3i :§'.. DOORS 63 0.350 22 ------ :------------------ ----------------------------------------------------- 7 A -12__ -----------.-----------_--.----------------_---- _h-__ C,-Rt.�__-?�i[i'=. -,- z-,-.-t_-------_.-,--_--.-=-.-s- -r ,-+-_ _ -- documents is consistent with the building plans, specifications, and other has been designed to meet the reauirerdgnts of the Massachusetts Enerav Code. has been determined using the aDvlicable Standard Design Conditions found :vim=_ T�__--_- shall be no greater than 125% of the design load as specified in K err, = i i - 3 A A GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. Permit Applicant Property address Map—/ Parcel Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me 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 subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 ofthe North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more ofthe following sections as indicated by a check mark This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as ofthe effective is bylaw, provided that no additional residential unit is created. The lots) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 ofthe Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all ofthe conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy ofthe units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land. For purposes ofthis section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicam must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY 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 I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUNDS FOR REFUSAL B BUILDING DEPARTMENT TO ISSUE A BUILDING PE T -t� o AIPPLIC SIGNA DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT . DIV. � •PHONE ?/0-- ASSESSORS /0= ASSESSORS MAP NUMBER / LOT NUMBER SUBDIVISION LOT NUMBER STREET STREET NUMBER OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS �................................................. ......... ..CG� ....... DATE APPROVED 00 C SERVATION ADMINSTRATOR Z DATE REJECTED �- DATE APPROVED /7 1 % 0 DATE REJECTED CON DENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEP INSPECTOR -HEALTH DATE REJECTED CON WNTS &21, PUBLIC WORKS - SEWER / WATER CONNEC NS Ja,,Mo 7-Z4 -% DRIVEWAY PERMT DATE APPROVED } FMDLfPARTKENT DATE REJECTED COMNfENTS RECEIVED BY BUILDING INSPECTOR T - A DPW 254 Date -7— z4 —,!go .......................... fAOR?h TOWN OF NORTH ANDOVER RECEIPT CHU This certifies that ....... (d ....... ...................... haspaid ............... \.. A n.. 0................................. for .... St:if1V(ff ooe Receivedby .......................... ..... . . ....................... jam Department ................. C ......... Wo .................. WHITE: Applicant CANARY: Department PINK: Treasurer CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE.1 "=40' DATE.7/21/2000 Scott L. Giles R. P. L. S. Frank. S. Giles 50 Deer Meadow Road NOTE. THE ZONING DIST. IS R-3. North Andover, Mass. I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BYLAWS OF NORTH ANDOVER WHEN BUILT OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE c yC DETERMINATION OF ZONING 0.13972 H CONFORMITY OR NON -CONFORMITY psi ��STExE�'�� WHEN CONSTRUCTED. �'TE LANO s 1549 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. J Application by the undersigned is hereby made to connect with the town sewer main in subject to the rules and regulations of the Division of Public Works. r Street, The premises are known as No, or subdivision lot no. Street 5752. Owner Address Contractor Address PP icant's Signature PERMIT TO CONNECT WITH EW The Division of Public Works hereby grants permission to ' to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date MAIN f Street Division of Pu lic Works By See back for rules and regulations 1 f a �✓llizasacltuJ�� '� v%iie � »:onan«�cx�1� TIONS � BOARD OF RUCTION SUPERVISOR License, CONSTRUCTION y Number CS 014197 Birthdate: 04/2411957 Expires: 04r2412002 Restricted To: 00 MARK F RAE 700 CHESTNUTST NO ANDOVER, MA 01845 Tr. no: 25538 -lif4f ow Administrator kok 3 H 9 T O z �1 un CA E—' U ci U 0 ai 3 c rD C: m - �ea LD •C 3 3 O 41 m u u L a I u o a _D E� a`, v a C a *D O v E o Cl Mnm L +r O o Cu a u v o m L �- a U1 t Ui �m v- 0 1 0 0 z I ui om c CD • : CO c c v o � Cc O o CJ y O3 L y EQ . L co 0 E =CL r) CD • + �, ` H CJ* l a. y CO vi fid o O E m aw m N m cc �C M O C �► C y Q _ dCL •� O O m N O p o�Z tJ Of y d C C = o C $ L:5 03 N ymoE- m Vi io L m LJJ C �• fl t ti •y MD o y Q C.3 m om�c F y CL m� O = eyv ��y•� O L S a,- m > z 0 w W Ico c, a •� CD Q -0 •E m m CD 0 CD 3� O CD o 0 cavo a CL Q y O c c cv � �L d O CR C Z CD C..3 to � C •� C O y D Cl) C/) Irw w ccw Cn O O a o Q O ro O C O v _C ro C 0 a C70 O cd C o w L1a p Qj u C x o V O C z ai C L cn v 0 O co ui om c CD • : CO c c v o � Cc O o CJ y O3 L y EQ . L co 0 E =CL r) CD • + �, ` H CJ* l a. y CO vi fid o O E m aw m N m cc �C M O C �► C y Q _ dCL •� O O m N O p o�Z tJ Of y d C C = o C $ L:5 03 N ymoE- m Vi io L m LJJ C �• fl t ti •y MD o y Q C.3 m om�c F y CL m� O = eyv ��y•� O L S a,- m > z 0 w W Ico c, a •� CD Q -0 •E m m CD 0 CD 3� O CD o 0 cavo a CL Q y O c c cv � �L d O CR C Z CD C..3 to � C •� C O y D Cl) C/) Irw w ccw Cn