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Miscellaneous - 855 WINTER STREET 4/30/2018
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IL 4 4 D,te ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... � - 0G%L // ..................................................................................... has permission to perform ...... X.. �M,/,4 .... . ................................ wiring in the building of .... at .. X......!.r1........-?= ............. . North Andover, Mas:W' Fee..,/ ... .. f .. Lic. Noh'ZJPI.,� R:�e.;_4 ELECTRICAL Cyo;t Check # C--' . z N " Office U� ~ _ The Commonwealth of kassa�chusetts ry'°" Department of Public Safety 0=*B CY s %e Checked . 7 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12.00 3/90 (Imm blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK. Ail work to. be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat _900.2— 2.7prd City or Town of 11019-77./ 1 --1-1�eZIr— To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ,�SOwner or Tenant _ C)-4 %NeJ-CAC .0 P_,Y24� l':!�s Owner's Address Is this permit in cordundiOnwith a building permit Yes ❑ No W Purpose of Building Existing Service L Amps Volts Overheac Now Senfte Amps / Volts Overhm it, Number of Feeders and Ampacity (Check Appropriate Box) Uffi ty Authorization No. ❑�Undgrd ❑ No. of Meters ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical work 0!5Pz n -s7 No. of Lighting Oudefs No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixturesimrrd Pool AboveIry m9 ❑ �, Generators q No. of Receptacle Outlets No. of OR Burners Ngo. of Uy Lighti nits No. nt Switch Outlets No. of Gas burners S of Zones tl d i Ing Devices /fContalned ontainedriding Devices nned []Other No. of Ranges No. of Air Cond. tons No. Disposals Heat 7 Totfx No of p s T KIN No. of Dishwashers Space/Area Heat KW Na of Dryers Heating D KW No. of water ers KW �'ns Ballad e No. Hydro Massage Tubs No. of Motors �j Toad HP OTHER: INSURANCE COVERAGE, Pursuant to the requirements of Massachusetts General Laws — I have a current Liability Insurance Policy Including Completed 9perations Coverage or Its substantial equivalent. YES E:r'NO ❑ I have submitted valid proof of sarne to this office. YES S NO ❑. 5 you have Checked please irate the type of coverage by dwx*ung the appropriate box. INSURANCE !J BOND ❑ OTHER ❑ (Please Spacify) _ Estimated Value of Electrical work $ /� �� (Expiration Date) Work to Start _ /Y5oq-0'• Signed under the penalties of owiunr FIRM NAME UC. NO. Licensee signature LIC. NO. Address—/%2 �� Se -!_3- �%'q f�` Bus. Tel. No. --�- �, AIL Tel. No. :Z/ / F_ee2% A OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner ❑ Agent ❑ pimse Check one) Telephone No. PERMIT FEE $. (S.ignalure of Owner or Agent) { �' n `i DATE IMMID0IYYYY) CO D, CEI TI�ICA'TE OF LIABILITY INSURANCE 09/27/2010 ' ' 7115 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER (7$1)893-1,345 FAX (781)8930810 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McQueen insurance Agency, Inc. MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 830 Moody Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P.O. Box 540570 INSURERS AFFORDING COVERAGE _ NAIC # Waltham, MA 02454-0570 wsuRERn: Mar land Casualty Co 19356 INSURED LEO T 0 NE1LL 7R DBA L T O 1111E'' TEL ELECTRIC INSURER IT y 137 WHITTEMORE STREET TEWKSBURY, MA 01876-1543 INSURER C: INSURER D: INSURFR E'. OVERAGES TRY REQUIRCMENT. TERM OR G)bNDIT10NOOF ANY CONTRACT Oft OTHER OCUMENT WITH R SPEGOTb WHICH IT IS GEIRTIF CAITE MAY BEI SIDED OR OFS AN MAY PERTAIN, ThiG INSURANCE AFFbRDED BY TME POLICIES t)ESCRIEIED WEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN RE4UCED BY fyAID ao ICY EFFECTI� POLICY E%PIRATIQN LIMITS A TYPE OF INSURANCE 43PNERAL LIABILITY COMMERCIAL GENERAL L"IUTY x CLHiwiS MADE IK OCCUR GFN'L AGGREGATE LIMIT APPLIES PER: POLICY JECCY LDC AUTOMOVILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTO& MIRED AUTOS NON•OWNEP AUTOS GARAGE LIAAILITY 7 ANY AUTO EXCESS/UMBRELLA LIABILITY 7 OCCUR 0 CLAIMS MADE OLOU � OBLE RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY 01 FICERIMEMBERIPARTNERXEXCLUDEO� ECUTIVE If v . dow1be lindbr . POLICY NUMBER CFMOZ84301Z3 DESCRIPTION OF OPFRATiONS I LOCATIONS 1 VEHICLES I EXCLUSI Town c.F Andover Wiring Inspector 36 Bartlet ST Andover, MA 01810 ACOR0 25 (2001108) FAX! (603)898-1876 03�z0�Z011 EACH OCCURRENCE S 1,000 OAMAGETORFNTED v 300 �yRFMISEC fFa accure➢L4� 10 MED EXF (AnY �� Pernon) a PERSONAL &ADV INJURY 1 000 GENERAL AGGREGATE PRODUCTS - COMPIOP AGG $ 2,00 OMNED INGLE LIMIT dS 60DILY INJURY $ (Per parson) SQmLY INJURY S (Per Rccident) PROPERTY DAMAGE 9 (Per accldenr) AUTO ONLY - EA ACCIDENT $ OTHER THAN FA ACC 3 AUTO ONLY: AGI $ EACH OCCURRENCE S AGGREGATE R 5 S S E.L. EACH ACCIDENT S F..LDISEASE- EAFMPLOYFE S E,L. DISEASE - POLICY LIMIT $ r SPSPECIAL PROVISIONS .. SHOULD ANY OF THE ABOVE DESCRIHED POLICIES BE CANCELLED EIEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL L-NDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THC LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IM S€ NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AG94TS 0 REPR SENTATIVES. AUTHORIZED REPRESENT _ f � • .._ _ CORPORATION 1988 9 4 tl Date.:.—.. .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..........f .......... has permission to perform ...... perfo /Z wiring in the building of... .......... .......................... ......... ............... Uj f �V-r-t at.................................................................................. . North And ver, Mass. Fee ..... ... .......... Lic. ....... .................... . ;., ... ... ............... ELECTRICAL INSPECToi( Check # Z 7 t Commonwealth of Massachusetts Official Use Only Department of Fire services Permit No. _ qil BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Allworkto be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER By this application the undersigned To the Inspector o Wires: gn gives notice of h' or her ' ntion o perform the electrical work described below. Location (Street & Number) � Wk� Sin' Owner or Tenant Owner's Address Telephone No. (p/? ggS-aW �YN �p.w (^ Is this permit in conjunction with a building permit? Purpose of Buildings 1 \� (Check Appropriate Box) _Utility Authorization No. /Uc.l� j E�sting Service �_ Amps jam/ a,y�7Volts Overhead Undgrd ❑ No. of Meters !n - -� _New Service Amps / Volts Overhead ❑ Undgrd ❑ No, of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion o the ollowin table may be waived by the Inspector o Wires. No. of Recessed Luminaires No. of Ceil.-Sus No. of Total p. (Paddle) Fans Transformers No, of Luminaire Outlets No. of Hot Tubs KVA Generators KVA No. of Luminaires Swimming Pool Above In, o. o mergency lg g d• d• Batt= Units No. of Receptacle Outlets No. of oil Burners FlyALAR>vIS No. of Zones No. of Switches No. of Gas Burners No. of Detection and No. of N Ranges Ran Initiatin Devices g o. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat Pip Number Tons KW o. of elf -Contained Totals: "-- _'___'_---"`--' No. of Dishwashers Space/Area Heating KW Detection/Aller-ting DevicesLocal io Municipal Connection ❑Other No. of Dryers Heating Appliances IAV Security Systems:* o. of Water No. of No. of Devices or E uivalent Imo' Heaters No. of Signs Ballasts . Data Wiring: No. Hydromassage BathtubsNo• of Devices or E uNalent No. of Motors Total HP Telecommunications firing: OTHER• No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. �- Estimated Value_ Electri al_W-ork: _ — c _ _ Work to Start igen°required_by municipal policy.) Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C GE: 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 permi CHECK ONE: INSURANCIA [3BOND OTHER I certify, under the pains and enaltxes o that the (Specify:) t issuing office. fP�)urJ', e information on this application is true and complete. FIRM NAME: Licensee: LIC. NO.: Signature 1110 (If applicable, enter "exempt " in the lice a number line.) LIC. NO.: ,S" Address: � � Bus. Tel. No. -- *Per M.G. c 147, s 57-61, security work requires D Alt. Tel. No.:17 OWNER'S INSURANCE WAIVER: I am aware thatl Department does not av' ' Linin se. Lic. No. ly required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ ownerco0 owner' agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 0 r The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street kip Boston, MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib)y Name (Business/Organization/Individual):Q� Address: City/State/Zip: ,/ It Phone #: 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. I S 'p 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.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other - —. -�-r--- - w:. r: —wiL WSQ 2m Unl [Be se -c -ac II oeiUR, showing their worr.�s' compensation policy info ration. 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 isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofpr rthat the information provided above is true and correct Sig -nature: Date: Official use only. Do not write in this area, to be completed by city or town of -ciaL City or Town: Permit/License # Issuing Authority (circle one): L 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 15.2, §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 permittlicense 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 Investibations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 4,,06 or 1-877-MASSAFE Fax # 617-72.7-7749 Revised 5-26-05 wwvw.mass.gov/dia Date. ?/.I. ,�/�U. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBINGO"' This certifies that...) ....... has permission to perform .... ............ plumbing in the buildings of D:r7'- � .......... at ... i ?-(I. . ......... North Andover, Mass. Fee. Lic. No./.� . . ....... . -VBIG . .. PLUMBING LU MINSPEMOR Check # 8650 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date J--/ e- /o Building Location b�S.r lv�',v�erG Permit Owner Amount Cj /1" i'C S 1 New ® Renovation 0 Replacement Plans Submitted Yes No UA FTXTiT1ZTC (Print or type) Installing Company Name 34S Q! v f N vdls� Address — yZ Tc)4 wSa -u 21 PW Name of Licensed Plumber: 3 i r" M Insurance Coverage: Indicate the type c Liability insurance policy El Check one: Certificate ❑ Corp. ElPartner. ante coverage by chmk-4heappropriate box: Other type of indemnity Bond ❑ Insurance Wever: L the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pert ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas usettss tosQe aria Chapter 142 of the General Laws. By: Title Type of Plumbing License City/Town � 3 rcense umoer Master Journeyman APPROVED (OFFICE USE ONLY �4 9 The Co1 54 mmonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Kashington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: BufldendCantrum Name (Business/Organization/Individual): 7:�q S PGv,vt h Address: �// T d4wso�v &_o City/State/Zip:=wls�'�-�, Ar V Phone #: y 7r— e-/3 - a 7-0 e you an employer., Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am 'a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. 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 3.[:] m a homeowner doing all work 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.) *,Amy applicant that checks.box 4l must also fill out the section beiox, 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 t Homeovrners who submit this of idavit indicating they are doing all work and then hireutside contractors must submit a4new affidavit indicating such. tContractors 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. Belom, is the po information licy and job site Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and a ties of perjury that the information provided above is true and correct 7If- J;/1-5' -a -7ce 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 #: A�_ 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 applicQuon 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 permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The. Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investibations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 vArwu1.mass._c,ov/di a PAY TO THE ORDER OF DUBOIS ELECTRIC, INC. 91 BELMONT ST. NORTH ANDOVER, MA 01845 vwni ©A A)a -/-k ne. ' 110 Loaf.. F"1 No Funds Refer to Makes Stale Date No Signature ACCte 1 fy6, i �. 1L")f r8E'B1�+134/2113 �0 W� t CIB � AF �rre�ove2.. zh.:_ me& 7'3-;38 € 3. Coy-opercativeBa nk Methuen, Mass. 01644 FOR ii'00 L796�i'-�-�:2 L L37 L340�: 23 �GO AV Oun da_° makelaDOLLARS 8 tStop P nt zinc F urda 0them ---- — —P 70 0 5u', .11000000 2s00." Q! I O - OW -5 �,iFI�YHMK BOSTON 3TON (AGENT) 1 ?5 FE DE RAL 81. I 361D OZ- i D - 97 00STOP4,MA.S-S. iayaDz z�Z97 r. Q! I O - OW -5 �,iFI�YHMK BOSTON 3TON (AGENT) 1 ?5 FE DE RAL 81. I 361D OZ- i D - 97 00STOP4,MA.S-S. 0 0 iayaDz z�Z97 Tq 0 0 Tq C(l I it MAR - 7-1997 r� - 1 Location `J� S No. /y, . '7 3l !-` 1 " Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ s- Building/Frame Permit Fee $ 7S& "US� Foundation Permit Fee $ r-1). ,5ir1 C) k ei Gthw Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ SD 1 Building Inspector 10794 cc it i Div. Public Works M I o + A ry ft. w w LA. (D M 13 rl Ad 4D v0 co k U) ru Lrl.. E iz e cc w to Z; O = 0 0 0 cu z q o D -4d IV 'n jo. 0 4D Q).,o pt v�n - u ON o 0 Z 0 w < cr. !Z co 0 — = C CD I 'n > t= Z M m0 0 p, c 10 D 0 0(n ca 6, C.0 > 0 cr L) ag co f Z z (D D Cd 0 'o , .4 1 C3 0 +.*, a) Z ic) 0 upt z .9 U > < Q (n U) c 0 E Ono Z- z U) 2 a 0 D :3 < c CD 4-1 0( (n CL - Z to Q a: !4 rm ru 0:3 Q cr F om 0 1.0 LL 0 0 V rm cn UJ 6.4 co cr U. -4 rteU. E >1 c 0 CLcc 0 1 f"U Z5 o ce L) Z d L13 LU w Ir WoM> B.S2 LLI W 00 Z a CD C (D d) Zcr LAJ ce U) z N ce 41)Q) 6 J= .4 UJ c ~ U. :zb c C3 x C3 LL; D 0 0 Q 0 IY Z w Z LU Cc 3c a 9c 834 etAORTH 0 «,,o 'q Date ...... 3 ................. ... ..... 7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACMUS This certifies that ..... . ..... .. .............................. has permission to perform .......... ..... "..x . ...................... wiring in the building pf .......... L-> .. C -In P.. ..... . .................................... at ................................................ 4 ............................. . North Andover, Mass. Fee..�q) ....... Lic. No. ................................................ . AL-1N-sPEcrOR COO WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i 694 Ot NO DTM 1ti A �`l ar oo� TOWN OF NORTH ANDOVER c PERMIT FOR WIRING $ �,SSACMUSEt + 4. 3' This certifies that ............... !Z... : ...... .......... has permission to perform ............. . m wirin in the building of ..... ..... .. .....� �.. ............................. ate . .... ......... , North Andover, Mass' �,% 49V�1, Fee.'i'�`�.....:'i Lc. No ........................................ mow. ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer office Use Only u E TamnIIInwrafth IIf -4ingar4imEtts Permit No. Occupancy & Fee Checked Bepartaltnt of Ilublit %fttq P cY 3/go (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 C'4R 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts EIectrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date % / 3 -, � (XYj or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street.& Number) GZ S / Owner or Tenant Q r Owner's Address 4---Na � r Is this permit in conjunction with a building permit: Yes No (Check Ap'proc�iate hoz) Purccse of Suildine l" C` lF` K r Utility Authorization Existing Service Amos —J Vcits Overread Unegrnd No. of Meters New Service CIO Amos / L/ 2- `t tits Overhead---tJncgrna r No. of Meters Numoer of Feeders and Amcacity Lccaticn and Nature of Prccosee Electrical 1.11crx li �"r `�y�? �-7` '� �'� L`'�zf ` r sl�rv1cc' Moral No. of L:g.^,ting Outlets I No. at Hc: ...bs No. of—ransformers KVA I Above— In - No. at Lighting Fixtures i Swimming Poo' grno _ cmc. _ ! Generators KVA No. of Emergency Lighting No. of Recectac'.e Outlets No. at Oil=urners Battery Units No. of Sw tcn Outlets No. or Gas Burners I FIRE ALARMS No. of Zones Totl a No. of Oetec:ion and No. of Ranges I No. of Air Cara. tens Initiating Oav cos No.o f Heat Total Total No. of Oisoosals Pumcs Tons K'�V y No. of Bouncing Devices No. of Sett Contained No. of Cisnwasners - ! ScaceiArea Heating KW Cetect:onrSounaing Oevices No. dt Orrers Heaund cev,ces KW L — Municiaai ^—Other, Local Cannec::on _ No. at No. of Low Voltage f No. of Water Heaters KN i Signs Ballasts Winnc „r No. :-tvcro 'Massage Tubs I No. of Motors Total iP OTHER. INSURANCE CCVERAGE: ?ursuant to the reeuirements at Massacnuset S ger,erai La _ _ ;ts s stantlal eeui nntt• — I have a current Liaetiity Insurance Policy including Camc:er a Oceraticns Coverage he rice of verage Cy have suornirtea valid proof of same to the Ottics. `!ES = 1 O _ It you ^ave c ~tease o�V checxing the acornate cox. INSURANCE tom' BONO = OTHER = (P!ease Scec:tyy (Exotration Cam Estimated Value of E!ec:ncal Warx S c Fnat �j Inseec::on Cate Aa Rougn Wdrx :o Start /_/� ` 9'p Signed under me Penalties of perjury 'La �S � FIRM NAN1E i L L e r C �-• LIC. NO. �-- C. NO. 3 a / C attire S Licensee L gn —� y d/—, -!` �-- Bus. Tel. NO. �/J r / _ �r jf I-1 6 1 /ice c--4-7 % s 6 s Alt. Tet. ^lo. ` Address f OWNERS INSURANCE WAIVER: I am aware that the Licensee aces nor nave dna nsurance coverage or its suostan�ta a':valent te- acOn ticatiowaives this re ire ent. Ow er duired by Massachusetts General Laws. and :hat my signature an :n:s oermit tP!ease cnecx onel 7aiecnone No. PE Ml FEc 5 (Signature at Owner or Agenn "''°' Location � � icy f �b' AA No. Date 7 - /C, �1 TOWN OF NORTH ANDOVER 3? • ° 0. p Certificate of Occupancy $ ♦ s ; • Building/Frame Permit Fee $ CMUe�� Foundation Permit -Fee $ sAs Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ B i"InsMtoori Div �I W > O Z O Z I Z 3 ' 0 0 U W N h ` ,�l ]yf Z O p N d LC d tom, j)� v N O N Z i% N 0 W 1 N m N m ~ o Oj IL U. O W N N �vi`\ Z < tL N J y 4 O O N z W f O V t� FN- la i k O ! Z _O f o j O F I 2w W I `e Z p LL O N N O > Z f U LL O < W W < i J o J O O J N Z O Z O N N Z 7 F F O C F F U l 11 z 7 Z 7 O C U C 2 7 O L _ N 0 N U bo JJuj H LU f- ci -1 Q O W 3 o o C) 1V O U C) _ i � •� h faf W s e IrZ W a .� Ix s o �, LL p to uw u Z 0 \ o z i d tJ ((�'��� J V • W � t Z o 1, �o Z nJo ° N Q C L J N 7 W a Z F L \ \ ( N W W Z J p - Z F f[ 1 O I� sr M �I V. 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This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 0, <. <✓n� Phone S 12_ _12Kti/ LOCATION: Assessor's Map Number 10,V-167 Subdivision% �� �650�� Street .S'iyrYV � ************************Official RECO NDA IO S TOWN AGENTS: Conservati4f Administrator Parcel 25'16 Lots) _ .A,4 St. Number _? Use Only************************ Date Approved Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector ----'Heaalth Date Rejected Date Approved 9 Y/ Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections 0'4 cl� TW `7-/0-Y��, - driveway permit —T I,J 7-6 Fire Department Received 115y Building Inspector SFP 2 5 1995 \1 Date G� Growth Management Bylaw Exemption St Town of North Andover Building Department atement �^ 1 This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of th Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. e Name of Applicant on Building Permit (below) ) Address of Property for Permit (below) Map and Parcel: —�� ��h �a� urpose of Application (check below) Phone Number of App Ican#: r/ , ;I_ 1766 _ Single Family _Two Family I the undersigned applicant for the above property attest that the attached building form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party for which this 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 Buildinrmit Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied g above lot, in the building permit application and associated attachments, complies with one or more of th following sections as indicated by a check mark. PP ed for on the e This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. -l./The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For Purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development proiect which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasibleiven the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/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. adjacThis application represents a tract of land �xisting and not held by a Developer in common ownership with an ent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Gr Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. Growth This resents a lot which Is comm ssi ns hl veibeenpre eived and he projectais in c mpldy for liiance with those permits a g permits,(i.e. all other permits from all other boards and does not accommodate issuing a building permit in that Year, one building Development until such time as the Development Schedule accommodates issuing build nd the Development Schedule supply approved form U with this EXEMPTION. permit will be issued per Year per g permits. Applicant must Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the ch��kin o permit is kn wled or not, is ro rids fo.h refusal f an above item which does not comply, y the Building Department to issue a Bilng Permit. to my i sign to a ofbwner or 'uth rized A enTBR� his form must be ttached to the i Ing Perm t upon aappl application fors such permit. Z La te SEP 2 5 1996 5 3 \ SEP 2 5 1996 I , l SD ol LA2 1 I . . ,N I �� :.011111; •., .Ill•, LC'....1, L.i1• , /K 19A i tj 1q � \ \ \, ��• // / � , ".11,1.. 1 '.I:. 1.('. .. � _ I .+�In . 1. 3NO1.S l], Jo .1 tJ V c•1 J. N V NO — ]laid Jo 1 N ht,11 il�3M01 1-- I C) Z Q a La C) w1lalb) VO 0= 0 Q W O LJL Z 0 O W = FUN ao C.)� ui V m A � dA L 5 w as a w (I.Q O &mq 9 z I- 04 0 u z 0 U cn w 7 J ;� 0AAQQA%A1Uact l5 FUNIFORM APPUCATION FOR PERMIT TO DO Pt_UMdtriL4 ��-1 (Print at Typal I . I NORTH ANDOVER, Mase. Oats QQ �7 Building PermK 32-S-7— l LP - Location � 5 �� i N.r e S 1 Owner's `.e•-1.) )�� Name -D . C New M'- Renovation ❑ Replacement ❑ Pians Submitted: Yes ❑ No. (gam Installing Company Address (O(n U Business Telephone 1 11)02S) -(10 WU —y(a5 % Name d Licensed Plumber Check one: Erdorp- ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: Checx one I have a current Ilabllfty Insurance policy or Its substantial equivalent. Yes ❑ No ❑ It you have checked y", please Indicate the type coverage by checking the appropriate box A liability insurance policy t7Other type d Indemnity ❑ Bond ❑ Certificate - - 93� OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 o( the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: signOwner ❑ Agent ❑ store o Owner a Owner s ant I hereby certify that all of the delaAs and information I have sutxrAted Ior entered( In above application us true and accurate to the best of my knowisdge and that all plumbing work and instailattons performed under the permit Issued br thla ap tion wn7 be in compflance with aH pertinent provisions of the Massachusetts State Ptumbing Cade and Chapter (3�wterat tams BY Q Title gnatmeLicensed Plumber CityRown License Number a 3 3 3 Type of Plumbing License: Master APIIXMD (OFFICE USE ONLY) Journeyman 0 al w w = X < » r A a i ` V �t h M = 7 O el� w s .QJ r1 el N= w s h V r W< M _ s s h U t z it at Q Q u< • < M ►� t < i< • r s w et O e. �r<t O _ < � < a16 ati r s U> h h N O» r �' : 00 Q st : o u 1L at til w s� M 0 Qs i sus—seMT. tAeaMtMT [ f 1eT FLOOR t� :No FLOOR 3 3 ( I SRO FLOOR 4TH FLOOR aTHFLOOR sTH FLOOR. 7TH FLOOR aTHfLOOK - Installing Company Address (O(n U Business Telephone 1 11)02S) -(10 WU —y(a5 % Name d Licensed Plumber Check one: Erdorp- ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: Checx one I have a current Ilabllfty Insurance policy or Its substantial equivalent. Yes ❑ No ❑ It you have checked y", please Indicate the type coverage by checking the appropriate box A liability insurance policy t7Other type d Indemnity ❑ Bond ❑ Certificate - - 93� OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 o( the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: signOwner ❑ Agent ❑ store o Owner a Owner s ant I hereby certify that all of the delaAs and information I have sutxrAted Ior entered( In above application us true and accurate to the best of my knowisdge and that all plumbing work and instailattons performed under the permit Issued br thla ap tion wn7 be in compflance with aH pertinent provisions of the Massachusetts State Ptumbing Cade and Chapter (3�wterat tams BY Q Title gnatmeLicensed Plumber CityRown License Number a 3 3 3 Type of Plumbing License: Master APIIXMD (OFFICE USE ONLY) Journeyman 0 Date.." �U.-..�, .. . 7 287 A i� TOWN OF NORTH ANDOVER p ° p PERMIT FOR PLUMBING ,SSACMUS� This certifies that { has permission to perform . �r��,• /�;:�f�fi�:�-P. .--•-• • • • • • • • o, plumbing in the buildings of . C.. (%�. • ...' at ...w�--a • . • • • • • • • • , North Andover, Mass. Fee..`NLic. No..(.j . .............................. PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Location 6IJ1f44:0 `i 4-1 4- )'7 No'. Date -7-10-96 r �o TOWN OF NORTH ANDOVER o� A Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �ildi Insge rtl Div. P lid``/Works 909 Location Y No. % %J Date r. r °aT;�tio TOWN OF NORTH ANDOVER _ - 6 p 09 ,, — v Certificate of Occupancy $ S Building/Frame Permit Fee $ 3"ACH' ��cMus E<h Foundation Permit Fee $ 12) ,Oj}r�aait Fee $ ... G,d'✓° '.. a.� a ,� R Sewer Connection Fee $ OCT 0 *7 Wats Konnection Fee $ NORTH ANDOVET@CftTi; p $ �` T:,:,� i Building In pector 10 3 3 9 �aio7/ is `� Div. Public Works W IL 0 Y m � � A Z � 3I U W p F X Z Z J N ^ C K N N N z ` 3 O N N � J 3 w a � ; 3� N F 1 J O 0 Z w 9 N 4 0 0 0 z � p p p N N Z 0 3 0 m N N W Ir 0 m O Z_ m J F O F Z J .0 U U W p m i _J O ¢_ E O Z Z Z 0` ►= N L 0 z O I N z z z O W N 1 4 Z U Z 0 0 0 pp _ 0 O O F 4 O U U U C 4 O 0 0 Z � 4 0 O ZZZZ V W N Z 4 0 0 4 J IL J J J J 0 'L Y 0 Z ( I O W - - - - K WN H < N F m m m m N d Z 0 1 W 0 p 4 U U. 0 Q 'W z ® z F W 0 f IJ � w z 0 a Z Q p W a 4q, tz 0 4 a� J Q Z J N w z f O m F Z 0 h Z f„ 0 Q 0 N W r C F O F K 0 N N E W < N J ; 0 H V < W Z f Z i W p J 0 W' z < < i z< O N Z 0 rc¢ 0 0 0 a p< Z < F N J Z_ Z_ Z J 4 �' O O N N W C U U U 4 O r W Q W W F p < < < O J J J m O IX a. z V Z Z V J F F F m m m m J < N-1 0 0< m o C o< N N N 3 m W z 0 (� f I' �g i z � � m ¢ C D d ` W W Z Q 0 a L 14p O p d U m m m U /7 J W W W m q 4-1 J J V .ri 3 0 0 U I O U S X31 1- < C W Z '\ O p W O Z p W < K J � l7 W < W � < Z W m m p 1p IL 4 J J V .ri 3 0 0 U I O U S X31 1- < C W Z '\ O p W O Z p W < K J � l7 W < W � < Z W m m p 1p IL 4 X31 1- < C W Z '\ O p W O Z p W < K J � l7 W < W � < Z W m m p 1p IL 4 w N N m D D 0 m Z - D w n. n D; N tll OOznnccmwmoo>4 DIOL ° W Anz�N DMZ 0000000-0, N S N �f Oro; CwN O ZmZZ000NS F -1 O-ZnzzzTZZO mTw mT 0 D;o -oO D m DZDNOZO0O;_pmZ D 0>Y w . mZnD; m3 C <� A w A m Z " O < m z oil ^ \! O n< OD - r ti O C T > ~ > O D m; D A Z III^S W T T? ? C r O m N S v A Z IY� rZI W N O =�:b� O On n =yo=n ZO a' D0 "i -0 yw Z n a A n r Z O �; Dpi O -� z:o A_ Q^ w A s ALL I I I, w ~I.x D z O O Z w I I _ � az o mom 0 0 �IIHI�: FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction' - have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: , COK/ Phone 32-3--7 LOCATION: Assessor's Map Number Parcel 2,r-2,'9' Subdivision/�sr�v1'�r�cee,�,� �sr-r' Lots) Street / /9 I-0, St. Number-afa _ ************************Official Use Only************************ RECOMME A O TOWN AGENTS: 777_ Date Approved �b Conservation Administrator Date Rejected Comments _ICR� f kl f__4 • Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector -Health Date Rejected — JV�4) Date Approved FA 7 h Sep is Inspector -Health Date Rejected Comments Public Works - sewer/water connections ok �e4l - driveway permit Fire Department 0J/ 126,S' ��qa(l_ wrist'( &12;,26/ �� 'c(�� ���7� /1"s,471 $ C Pis Pu- oaw-r807 city 61- -pea—Ir-p- To. �✓� �a/l� Received by Building Inspector Date s 4 b E m CO V+ r cc . - • U �- U, m R R = •dam WW vI 0 _ ac E �oc"Dti W p, • ' ti v) 0-0 . Fr s Qcnoz m o� �'. CO O a. = E m CO V+ r cc . - • ?;a..,x. �- •y H m R R = •dam o - Z vI _ ac E �oc"Dti o C • ' ti m 0-0 s Qcnoz m o� �'. CO O a. = 466t 'ZZ '1d3S :31VO 11 �:�.s-rrr ls:ovf II\'�.11''Inugnurl Ii.131•tif'r I Lill, ns 1 LI1 YtC `Taal leuo l` ann•�,�F• ap'.Lkit' G�VN�y GR��B��S NSF �SSfLX �z+'E N�yyd I F- N M f- W N V1 0 LL W 2 Z ~ n �l N N N/F GREEN �a LOT to J• . N Y • O -W N/F GREEN _. e u " LOT 2A Qf x. . w ry yy O U) J O •0 C3 g L r Q' Q A 7 �( } 4'1. CKI 1ry9y�3SV3 +'� W J EL bg a _ _ A; l ++tib off' b J O O CT m }, Calc a 0' V 0 o o V 07 a I Z N aI L W 0 z 300 N0I1dI82S3o n38 SbglO VW 'M3AOONV 1-1118ON 0 .- OS=.t :31VOS 13381S 831NIM 959 N332I9 Sd19f100 OlAda o maj 038vd3Ed 0) S113snH3VSSd VV '2!3/�0QN`d H1zi0N INItl 71aIJ•�•NI!7�H:i NI g ~ W "All 'salttil:)Qqv g T aN`dI J0 N`dId a w N �n�Opj��l:NMtltlO j/ u It. '03>t73H7 '03NDiS30 Z� C, ¢ Q J O p LU ¢OQp rn ¢O�zU L. .. zQto k zaaa Q. co -n ¢p ¢ -H Z j W Ld~Z¢ W co 1•- } z p ti ¢ ; o O ? o CL II �� 1L w u 2 cv to Zp --, .CL.-` p = a W Z V1N V) ¢ m 0i a: W OW '.Wp p Oa Orn 3 QV b ¢ tna! mW OZ m �WpWOIpo.- •�- oQ ". �. ¢- C7Q WOC, 0 �y o WO¢ W� ~= >4a22 - tea J r�lr .` v 11_ ca �zLj O � in ZCO0 OU � � z2 _ - .�_¢.1 U, in vi pul in In Co¢ W p W Z L, W p F ¢¢ Z 47 1•L O O in 0 cc -jZ W ¢ 0¢01 �' o WJ7< 1 t- m ¢ m¢ Q. Q. ul o wWo w oma= n W Uo:— rr 4�c�iZ v3o 0 �W -1 2 W Q� ��U p ¢WOJW WQ¢ W t� Vl¢ �W O2 N 3 mW OYZaZ O UO U� O ZI-?¢F0:1 ack G�VN�y GR��B��S NSF �SSfLX �z+'E N�yyd I F- N M f- W N V1 0 LL W 2 Z ~ n �l N N N/F GREEN �a LOT to J• . N Y • O -W N/F GREEN _. e u " LOT 2A Qf x. . w ry yy O U) J O •0 C3 g L r Q' Q A 7 �( } 4'1. CKI 1ry9y�3SV3 +'� W J EL bg a _ _ A; l ++tib off' b J O O CT m }, Calc a 0' V 0 o o V 07 a I Z N aI L W 0 z _OERTI FIC f T( wilding Permit Number THE BUILDING LOCAi MAY BE OCCUPIED A WITH THE PROVISION SUCH OTHER REGULA ' --E OF USE & OCCUPANCY !n of North Andover Date cc) THIS CERTIFIES THAT f ON j l I ��«/ /yIN ACCORDANCE F THE MASSACHUSETTS STATE BUILDING CODE AND i dS AS MAY APPLY. r o, M' "' .,, ;"CdFICATE ISSUED TOO/J 7Y .o 9 ADDRESS�'� ''s,CHYmilu�pector NO 0 ell, I , \\A\ \-) �, � 1 1 7 CD 0 � a°' o w' cn cn 1 1 7 CD 0 � c s0 O0 pq aCc a oCD CD r d O C If WWd \ m O u E I j...1NG Ppp ccmy E m N ,� 0 c (� .0 ~L C H C y O ca 0 `L D O p CM O) y i C yQ � act COD scm V •y O O c v. o COMc m y O C Q = +O. CL .. D H O y0 t W CCO 00-'0 _.. w (� O C w E C Z o o y_ 43 a m��3 CL g aoN o �- z $ am v 2 W f O 0 't3 a� 0 E � o � w Z co CL O CO) � C co I C cm C CD 0 y O O m m co 0 co d. ..r CD O O i � � d CM < CO2 C o � cv 2 •C Z co �..� y C O C c is The Commonwealth of Massachusetts tl:tice Use � Ont CtI Permit No: Department of Public Safety Occupancy & Fee Checked (,t' BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Matrschusetu Electrical Code, S277R R 1 E00 (PLEASE PRINT IN INK OREE IN RHATION) Date 1% City or Town of To the Inspector of Wires: The undersigned applies for a permit to perf prm/the ele5trica work described below, c Loation (Street & Number) Qom,heA in T w, q t Owner or Owner's Address Is this permit in conjunction withi a build'permit: Yes 11No2 (Check Appropriate Box) Purpose of Building -Q / Utility Authorization N0, Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Metes Number of Feeders and Arpacity Location and Nature of Proposed Electrical Work lv No. of Lighting Outlets No. of Hot Iubs No. of Transformers Total KVA No. of Lighting Fixtures 8 g Above In - Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle OutletsNo. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal ❑ Other Connection .70. of Ranges No. of Air Cond. Total tons No. of Disposals No. of Heat Iotal Totalpumos Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters No. of ISifnsf Ballasts Low Wirinoltage No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES& NO [] I have submitted valid proof of same to this office. YES ® NO 0 If you have checked YES, please indicate the type of cove e b _S y ch king the appropriate box. INSURANCE � BOND ❑ OTHER 1:] (Please Specify) / I?AA? �-� 1a1321 Ex iration D ) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Roug Signed under the enalties of perjury: FIRM NAiO: ���j� �/y;C��T�%C Lic^_nsee S- 14 �/ ZLI0 S Address 16 Z LIC. NO. j Y3 3 LIC.. NO. 14 S9 3.3 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. Signature of Owner or Agent PERMIT FEE S / �. _-._,=_.-r,..• .�>-�.-.tea...-: aR•s+l'�",,. •;„. , . ` Date .......��l.ia.. To NOR7M O 9 ,SSACMUSEt . TOWN OF NORTH ANDOVER PERMIT FOR WIRING J ,_,� . This certifies that j Y c Y�.. c....!................................................................. has permission to perform ......��..�.f2.�' ` i1... .....................:..................................... wiring in the building of ..... !� e. .............................................................. at....... ........................ . North Andover, Mass. .................. Fee.. / ' O�..... Lic. No. el 2J............................................................ ELECTRICALINSPECTOR 1r 04/1//%-�11 e345 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Location `�s�. No. C;�3 Date TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ cMus Eta Building/Frame Permit Fee $ _ Foundation Permit Fee $ _ ,-" Other Permit Fee $ TOTAL $ c22 Check # '17693 Building Inspe ,17— 4 1.1 Property Address: I/l/ G 1.2 Assessors Map and Parcel I��3 Map Number Number: a��l Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1 1.7 Water Supply M.G.L.C.40. 34) Public ❑ Private ❑ 1.5. Flood Zone Information: zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT ("J: "? 2.1 Owner of Record GW� 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES 31, Licensed Construction Supervisor: CS o,--),3365 Licensed Construction Supervisor: S ( ✓ i Telephone 3.2 Registered Home Improvement S Address for Service : Address for Service: Not Applicable ❑ License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date o 0.3 v 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 Dermit. Signed affidavit Attached Yes .......0 No ....... ❑ SECTION 5 Descri tion of Proposed Work check ad a cable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: l Roo sC— I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building t� 6 t (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) Q 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 b 0777-1 Check Number bt%-ItU.N is UW14e,x AU lnUM11,Al1UIN 1U BE UUMPLETED WHEN --OVfgftS A99NT O NTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to wo au orized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHO ZED AGENT DECLARATION 1, As Owner/Authorized Agent of subject property Hereby declare that the statements and information on the .foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si ature of Owner/Arent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IS 2' 3 RD SPAN DIlVEENSIONS OF SELLS DUviENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE w I a E Mo Z h N m CO c CC 16.O cm c 'c t 0 Z O 0 I 96 O � L O Z � OL O y � C _ 0� pm I O� A di O �E m m ow O � O cc oa cm< O c cc Q 10 . o CD co c Z s CL C.3 ca O C _ cc C C CO)uj LLI Y/ W W oc W N . Cd O H U CD c a c� O O rA Cc x CC3 V x w CD CD � ow U � � a o is VJ C (002 A CD y O cii m w° o°G U X0. C7 WW a o cn cn E Mo Z h N m CO c CC 16.O cm c 'c t 0 Z O 0 I 96 O � L O Z � OL O y � C _ 0� pm I O� A di O �E m m ow O � O cc oa cm< O c cc Q 10 . o CD co c Z s CL C.3 ca O C _ cc C C CO)uj LLI Y/ W W oc W N C Is CD c c� O O rA Cc CC3 V C CD CD yr a o is VJ C (002 CD y O c O C_ oS t = w, O 'O 4 093MIA �o� 10 ra co ao a m :ado W w.IS Z LLJ M CLJ H IC E �., C.i v, x� c co o— JD M.CL= m E Mo Z h N m CO c CC 16.O cm c 'c t 0 Z O 0 I 96 O � L O Z � OL O y � C _ 0� pm I O� A di O �E m m ow O � O cc oa cm< O c cc Q 10 . o CD co c Z s CL C.3 ca O C _ cc C C CO)uj LLI Y/ W W oc W N ,. ✓� f009ft/pt04tll/E� O� il/GQb.4�•[GP.�6 � � m; BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR NumberCSt 023365 BirthdAte ;`1`2%04%1957 �zpi4s 1'2/04120,05 Tr. no: 12107 Restricted:" 00` DAVID REITANO` ".` 56 PLEASANT STREET ; METHUEN, MA 01844 Acting ` of miss net �i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 . Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # 0 I am a homeowner performing all work myself. F] I am a sole proprietor and have no one working in any capacity 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 af,a fine up to $1,500.00 and/or one years' imprisonment_as.voe -as_cimi..penaltiesinlhelam da -STOP WORK..ORDER..a d..a.fine of.(5100.DD).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 hereby ►tify u er pains a n tie equry that the information provided above is true and correct. Signature Date / G—. — p L/ Print name f� Phone # 6 �f Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensin ❑ Building Dept []Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #.• ❑ Health Department ❑ Other GENERAL CONTRACTORS 56 Pleasant Street Methuen, MA 01844 Phone/Fax: 978-688-3944 Company Email: Daviditeitano0comcast.net NumbalCont+actor0hotmail.aom Proposal Date: August 3, 2004 Submit To: Mr. & Mrs. Green 855 Winter Street North Andover, MA 01845 Home No: 978-794-0657 Sob Description: General Repairs We hereby submit specifications and estimates tor. *Existing asphalt shingles on main house will be removed completely - all debris will be removed from job site - Contractorwill supply dumpster - dumpster location to be confirmed prior to construction. *Existing sheathing will be inspected and replaced where necessary, Contractor allowed for approximately 64 sq. ft. of plywood' sheating. *8" aluminum drip edge will be installed around complete edges. *Ice and water shield will be installed on lower 6 ft. of main house, remaining areas to be covered with 30 Ib. felt. *All flashing to be inspected and replaced where necessary. Vinyl continuous ridge vent to be installed on main house. *25 yr, 3 tab, asphalt shingles will be installed on main house as well. J�*Breezewa / ara a roof to be resurfaced with structo-dec fiberboard material i r Y 9 9 type n preparation for a rubber roof. *White aluminum drip edge to be installed around' complete perimeter in preparation for rubber material. Rubber material to be properly adhered to structo-dec and terminated into main house. f Existing left side entry into breezeway/ will be removed completely and re -framed and ed in 9a� P �Y PM�►� preparation for siding. *Block foundation in same area as well as concrete floor damaged! area will be removed' and replaced with a new section of foundation "ncrete floor. Exact dimensions repaired will be confirmed prior to construction. 0 0 r ,, ... .... -.s ... ._ r.. s.. ,._, � � .. � r: ...... :.. :..... � . �� ,3 .„._ ,. .., .. ....., �. ... .. , .. o 0 *All windows in main house to be removed and replaced with Harvey Vinyl 7/8 insulated Low E glass Classic type windows. The majority of windows to be double -hung, grid pattern to be confirmed. Living room and kitchen area windows tor be replaced with similar style, which are picture windows with double hung flankers. Windows will be insulated with fiberglass insulation and properly sealed and fastened. Tont entry will be removed and replaced with a Fiberglass door unit - exact style to be confirmed prior to nstruction. Door unit includes proper installation, insulation, interior and exterior trim to compliment existing as closely as possible, as well as a solid core vinyl storm door and includes deadbolt and knob hardware. *f=ront wall of breeezeway/garage will be re -framed to accommodate two (2) 9 ft. maintenance free insulated grarage doors. Framing preparation also includes foundation .modifications. *Existing front breezeway door will be remove completely and replaced with a fiberglass door unit to compliment main door unit. Exact style, size, etc. to be confirmed' prior to construction. Installation also includes proper insulation around complete perimeter, interior and exterior finish to compliment existing as closely as possible, as well as deadboit and knob hardware. *Existing sidingi on main house will be removed' completely to expose sheathing, miscellaneous repairs on sheathing include in overall price, especially around/rear of property, which will include framing, insulation, sheathing, etc. to left and right side of chimneyN preezeway wall, approximately 16 ft. will be removed completely and re -framed to accommodate a new 36 x 80 fiberglass door unit and two (2) Harvey vinyl windows to compliment main house.. Construction also includes proper insulation, bluboard, plaster, interior trim,%xterw finish ( ). *Electrical in wall mentioned above to be confirmed prior to construction is not included in price. *Existing chimney to be inspected, flashing replaced and re -pointe. *Complete house, including garage/breezeway, to be re -sided with Mastic T -Loc solid vinyl siding including Tyvek building fabric under siding. All electrical will be removed and replaced properly prior to siding installation. Horne will be inspected for any decay and decay wilt be removed' and replaced i with new solid material'All trim including window sills, window casings, door casings, fascia boards, rake boards, etc. will be covered with aluminum. All overhangs will be covered with vinyl perforated soffit material. *Existing driveway to be excavated and removed completely. Homeowner is responsible for loan and finished grading, grass, etc. *Proposed garage area to be excavated to accommodate new driveway, proper groin preparation, stone, gravel for drainage and finished asphalt. More discussion needed - allowance outlined below. *Existing vinyl + floor in rear entry/mudroom area and kitchen will be removed completely and floor prepared for ceramic tile throughout area mentioned. *Existing kitchen cabinetry will be removed completely, all debris will be remove from job site. *New cabinets to be installed' in similar foot print style of cabinets, countertops, etc. to be confirmed - allowances for countertops and cabinetry outlined below and also includes electrical modifications in these area. *Bathroom located on second floor will be dernoed completely to expose framing — all debris to be removed from job site. All plumbing will be updated to meet Mass Code requirements including water supplies, shutoffs, drains, etc. Tub to be a 5 ft. Jacuzzi — allowance outlined below. *All electrical will be update to meet Mass Code requirements as well including ceiling light/fan combination, GFI receptacle (2), proper switches for independent lighting above individual sinks. Electrical allowances outlined below. 0 *All walls will be insulated with fiberglass insulation. 101 *Ali walls and ceiling will be resurfaced with 1/2" bluboard in preparation for piaster supplied by Contractor. *Cabinetry to include in master bath, linen closet 18 to 24" wide and a 60" (approximately) long vanity with double bowl sinks — exact style and layout to be confirmed prior to construction — as well as a laminate countertop. *All fixtures including toilet, tub and shower valve, faucets, medicine cabinets, and Jacuzzi — allowances outlined below. Floor finish to be file — material allowance outlined below. *Hardwood' floors throughout complete second floor and parquet floor in main living room area, as well as staircase to be completely sanded and re -finished including three (3) coats of urethane — finish to be confirmed prior to construction. *Railing at base of stairs leading to second floor to be installed — exact style to be confirmed — Contractor figured' Newell posts, railing, complimentary balusters, as well as railing going up wall. *Two (2) supporting columns located in family room/living room area to be removed completely — area to be prepared to receive a still I beam. Contractor is responsible for blending steel I beam into existing ceiling as well as blending existing knotty pine disturbed during construction. *Closet located in second floor rear right comer (daughter's room) sheetrock will be removed from walls and ceiling completely. Closet will be re -insulated and resurfaced with bluboard and plastered as well as miscellaneous moldings. *Master bedroom closet to have ceiling, damaged by water, this are to be removed, re -plastered in preparation for paint supplied by Homeowner. *Three rooms discussed to be weldabonded in preparation for plaster supplied' by Contractor — more discussion needed — exact rooms to be confirmed prior to construction. Roofing/Main House: $ 6,400.00 100 Re -side Main House: $10,750.00 Re -Roof Garage: 6,900.00 Garage Floor Repair: 3,400.00 Block Garage Door/Side Entry: $425.00 Two Windows Side of Garage: $950.00 --� Cut block to accommodate two (2) garage doors: $1,200.00 t �. Frame Openings to accommodate Garage doors: 3,200.00 �\ i —Installation of two (2) garage doors with openers: 1,900.00 ¢ Electric — Two (2) garage doors: $450.00 Front breezeway entry: $825.00 Main front entry, $1,375.00 Rear Breezeway wall remove And rebuild: $4,025.00 Re -point Chimney: 875.00 Repair wall decay around Chimney: $1,225.00 Eight (8) Harvey double hung windows: $2,600.00 �Q 0` Two Harvey windows/Pi enter Three (3) 5 Core sash and double hung flankers: $2,240.00 storm doors: $675.00 /110, Driveway excavation & removal: Second floor bath complete: Tile Floor: $3,420.00 Railing system: $1,675.00 Restore daughter's closet: $1,800.00 Walk-in closet repair: No Charge $2,400.00 --Driveway excavate stone & New asphalt: $6,400.00 $14,875.00 Refinish hardwood floors: $1,850.00 Kitchen: $13,900.00 Living room column removal: $3,400.00 Weldabond & Plaster 3 rooms.- $3,200.00 Above Total: $ 102,335.00 Bathroom Allowances/Included: Tile Floor/Material: $ 450.00 Tile Walls/Material: 450.00 JacuzziTub: 800.00 Tub & Shower Valve/Symonds Included Vanity 60" (Bathroom): 425.00 Sinks/Two (2)/$80.00 each 160.00 Toilet: 150.00 Faucets/Two (2) 0150.00 each: 300.00 Two Mirrors: 200.00 18" Linen Closet: 375.00 Laminate Countertop: Included Three (3) Wall Sconces: 240.00 Kitchen Allowances/Included: Cabinetry: $ 3,800.00 Laminate Countertop: Included Sink: 240.00 Faucet: 200.00 *Contractor is responsible for allowances mentioned, anything that exceeds these allowances - Homeowner is responsible for. *Homeowner is responsible for paint and stain. *Please review this proposal carefully for any items which may be missing. Contractor is not responsible for items not mentioned here. 1. •. p ���: �1.' Y, ,� .. .. 't� t. .. � .. 1