HomeMy WebLinkAboutMiscellaneous - 87 FOXWOOD DRIVE 4/30/2018Date .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..........v.. ZZ-4�7— 49—
. .....................................................................
has permission to perform ...... ./.......v . ........................................
wiring in the building of .............................. .......................................
at ....... ?.7 .......... ........... -1, North Andover Mass.
c. No. ............ .......
............. Li ���1?3- w . . . ......... .
Check # PLE�CTRICAL INSP��f -t�
9074
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1Jsparintsr� o�„tira �awicae
BOARD OF FIRE PREVENTION REGULATIONS
For Office Use Only
Permitt Number: (Rev. q® 7z/
um
Occupancy & Fee
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
(ALL WORK TO BE PERFORMED Wmi THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12;00)
PLEASE PRINT IN INK OR TYPE ALL INFORMATION Dater
City or Town of: ,Alfa, ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to erform the electrical work described below.
Location: (Street & Number) D / �(%�
Owner or Tenant: j .P ) e asa 1
Owner's Address: _S .�y►q,Q
Is this permit in conjunction with a/I Building Permit? Yes o No IL/ (Check Appropriate Box)
Purpose of Building: g (-e t, Utility Authorization #:
Existing Service: Amps / Volts Overhead ❑ Underground. ❑ # of Meters
New Service: Amps / Volts Overhead ❑ Underground.❑ # of Meters:
Number of Feeders and Ampacity:
Location and Nature of Proposed Electrical Work: ll`e p (JI,
No, of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Transformers Total KVA
No. Of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures .
Swimming Pool: Above ground o In Ground o
# of Emergency Lighting Battery Units
No. of Receptacle Outlets
No. of Oil Burners
Fire Alarms # of Zones
# of Detection & Initiating Devices
# of Sounding Devices:
# of Self Contained
Detection/Sounding Devices
Local ❑ Municipal Connection o Other o
No. of Switches
No. of Gas Burners
No. of Ranges
No. of Air Conditioners TOTAL TONS:
No. of Waste Disposals
Heat Pump Totals:
Number: TONS: KW:
Security Systems:
No, of Devices or Equivalent
No. of Dishwashers
Space /Area Heating: KW
Data Wiring, No. of Devices or Equivalent:
No. of Dryers ...
Heating Appliances KW
Telecommunications Wiring: No of Devices or
Equivalent:
No. of Water Heaters KW
No. of Signs: # of Ballasts:
OTHER;
# of Hydro Massage Tubs
No. of Motors Total HP
INSURANCE COVERAGE: Unless waived by the owner, no pe for the performance of electrical work may issue unless the licensee provides proof of liability insurance
including "completed operation" coverage or its substantial equi lent. The undersigned certifies that such coverage is in force, and has a hibited proof of same to the permit
issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER C3Please specify: /AJ� !
cam"
Estimated Value of Electrical
(When required by municipal policy)
Work to Start: 10 /U /01 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I artify, er the pains and penal !es of perjury, that the Information on this application is true and complete.
Firm Name: (% 1
LIC. #141�
Licensee: Signature: LIC. #.
/ py/licabl/ e, epter,�e a tin the numberGllne) / ,�j�
Address:�� ll i uA o t � /y' /J, /l % l� 1 *31
QIIC 7GI }! AI4 T..I it
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 o OR Agent ❑
Signature of Owner/Agent: Telephone #
rPERMIT FEE: S —�
Id
Date. � /-� / A - -
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ...
has permission to perform ...�. ..... �J
.....................
plumbing in the buildings of ... ........................
at. . 7 . rA �.Llt- ................. North Andover, Mass.
Fee. Lic. No.. . ........ .*.-.-? .........
PLUMBING INSPECTOR
Check # A1 ?1
837
I
1
INSURANCE COVERAGE:
I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Sianature of Owner or Owner's Aaent
I hereby certify that all of the details and information I have submitted (or entered) regard' thi pplication are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit i ed f is application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 ral Laws.
By
Title
City/Town
APPROVED (OFFICE USE ONE
Type of License:El
PI r Signat re of Licensed Plumber
aster
❑Journeyman License Number:
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
CitylTown:.,L , MA. Date: Permit#
a
Building Location: S9 �oXi nms D(� V e Owners Name:�Cr
Type of Occupancy: Commercial ❑ Educational E[] Industrial ❑ Institutional ❑ Residential
New: ❑ Alteration: Mr Renovation: ❑ Replacement: ❑' Plans Submitted: Yes ❑ No
FIXTURES
INSURANCE COVERAGE:
I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Sianature of Owner or Owner's Aaent
I hereby certify that all of the details and information I have submitted (or entered) regard' thi pplication are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit i ed f is application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 ral Laws.
By
Title
City/Town
APPROVED (OFFICE USE ONE
Type of License:El
PI r Signat re of Licensed Plumber
aster
❑Journeyman License Number:
FIXTURES
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1 FLOOR
2 NuFLOOR
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a OnlyCertificate#
Installing Company Name:
9�!L"Aation
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Address: `
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City/Town:
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State: '��.
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❑ Partnership
Business Tel:01,1;
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Fax:
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❑Firm/Company
Name of Licensed Plumber:
d
INSURANCE COVERAGE:
I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Sianature of Owner or Owner's Aaent
I hereby certify that all of the details and information I have submitted (or entered) regard' thi pplication are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit i ed f is application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 ral Laws.
By
Title
City/Town
APPROVED (OFFICE USE ONE
Type of License:El
PI r Signat re of Licensed Plumber
aster
❑Journeyman License Number:
95bu Date .......
..... .... ... . ...
0"0","
TOWN OF NORTH ANDOVER
(Irso' PERMIT FOR WIRING
t.
This certifies that ............... 6m ... .... .............................
has permission to perform .......
............ 5...
wiring in- the building of ................ IP/ E..... ...........E'1/..'..................................
.......
....................................
at 1%7 ....... J5�Vwob ............ !� ........................ I North Andover, Mass.
— -41
Fee ....3......j.....t......—Lic. No../ " 7
.!Pp.d . .................... 4.4 ...... �..
ELECTRICAL INSPECTOAi
Check #
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vvnnuvllrr�pliu vI I�IWJJf/irI/MJViiJ ���Q
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number)_
Owner or Tenant l%�yti
Owner's Address
Telephone No.
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity n
Location and Nature of Proposed Electrical Work:
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- ❑
rnd. grnd.
No—.of mergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I 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
Totals:
Number
......................................................
Tons
KW
No. of Self-Contained
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
p g
Local ❑ Municipal El Other
Connection
No. of Dryers
Heating Appliances KW
Systems:*
SecuritNo. of Devices or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND [:1- OTHER ❑ (Specify:)
I certify, under the pains and p nalties ofperjury, that the information on this applicatio is true and complete.
FIRM NAME: LIC. NO.:
Licensee: ticvt Signatu re LIC. NO.: tOOIR 7
(If applicable, nter "e pt" in the license umb r line.) Bus. Tel. No.
Address:/`� S sltJl�kct al �Z/ Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, 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) ❑ ower ❑ owner's
Owner/Agent
Signature Telephone No. PERMIT FEE. $
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
Name (Business/Organization/Individual):
Address: 1CGrJa�
City/State/Zip:__ /fib(( Z ( V z-- C Phone #: o20
Are you an employer? Check the appropriate box:
L ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. I am a sole proprietor or partner- listed on the attached sheet. $
ship and have no employees These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance 5. ❑
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.]
workers' comp. insurance.
We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.0 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.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lie. #:
Job Site
Expiration Date:
City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi er the painj.,,and pffgXes ofperjury that the information provided aboy 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 #:
Location
i
No. / Date A
'-v
NORTH
TOWN OF NORTH
ANDOVER
O:1.{O
a ; a
Certificate of Occupancy
$
s,a4us
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check #
4 3 , .
Building Inspl r
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
��,5� ,q�`�
BUILDING PERMIT NUMBER: DATE ISSUED: �� O
SIGNATURE.
Building Commissioner/12EMtor of Buildings Date • • t P"=�O
SECTION 1- SITE INFORMATION
1.1 Property.Address: 1.2 Assessors Map and Parcel Number:
"0 - ,
Map Number . Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required -+ Provided R red Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of R rd
t.l
Name (Print) Address for Service :
Signature Telephone
2.2 Owner of Record:
2•itame Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
/ ! Registration Numbe
Addres
�/ b(�' gy
V Expiration Date
Signature Telephone
r
SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......0 No ....... ❑
SECTION 5 Description of Proposed Work(check all applicable)
New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work- � a
'0 r
for) 61
5�t? ;' r- J"�' r C-" /-/ �;'�o CJ'V
SECTION 6 - E9TIMATED CONSTRU TTON COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL VSE ONLY
1. Building
(a) Building Permit Fee
Multi tier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
�S
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
t Q.
Check Number
SECTION 7a OWNER AU' ORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR C N TOR APPLIE G PERMIT
I> as Owner/Authorized Agent of subject property
Hereby autho / e to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
i> as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/Agent Date
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Department of Industrial Accidents
` Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
Ci '72��(/
/Phone
am a omen er performing all work myself
m a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employ es working on this job.
(''mmnanv name'
Company name:
Address
City Phone#:
Insurance Co. Policv #
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
andlor 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. 1
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
Y do herby certify under the pains and penalties
Signature
Print
the information provided above is bue and correct
Official use only do not write in this area to be completed by city or town official'
❑Check d immediate response is required ' Building Dept
Contact
FORM WORKMAN'S COMPENSATION
Date
C]
Building Dept
C]
Licensing Board
p
Selectman's Office
Health Department
0
Other
HOME IMPROVEMENT CONTRACTOR
Registration 111113 tt
Type - DBA
Expiration 08/25/g8
2.
J.A.S. REMODELING CONTR
JOSEPH A. SHAW
G�oT 6�lASHINGTON WAY
ADMINISTRATOR ,' NGSTON.NH 03898'
v
Af
Town of North Andover ti Nark
. 0 1tut0 167 'YO
Building Department o 2
27 Charles Street
North Andover, Massachusetts 01845
978 688-9545 Fax 978 688-9542
.r RAreo rP�tLy
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and.a condition of
Building permit # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will %be disposed of in /at:
Facility location
Sig e of Applicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
• . � � ,: car^.
MASSACHUSETTS UNIFORM APPLICATION -FOR.PER
MITTO.pO°PLUM6LN-G
(Type or Print)
Date: ,:..;,.�
NORTH ANDOVER ,Mass. .
a
Building Location 00.Y Permit 3y
Owners
tv� New 12' Renovation Replacement [�
FIXTURE
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Name
Plan
A:.
•:fit
:
(Print or Type) Check one: Certificate
Installing Company Name 6�ma-y'dy Rud •l"wo, (� Corp.
Address T V Partner.
"'Firm/Co.
Business Tele hone
Name of Licensed Plumber: PA �Ilt 0V
$. .
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnity Q Bond
Insurance Waiver: !, the undersigned, have been made aware .that the licensee of 1 --
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner Agenf\•
I hereby certify that all of the details and information 1 have submitted (or en(cmd) in ahavc application ate true and s We to Ute be of Illy '• .
knowledge and that all plumbing work and installations licrfotntcd under Permit i t%ucd for (his application will be in eomptianee with all palinept pro. ;d
wisions of the Massachusetts State Plumbing Code and Chaplet 142 of lite Ccnual Laws.
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APPROVED TOFFICE USE ONLY)
nature of L censed Plumt�e�c
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4TH FLOOR
STH FLOOR
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6TH FLOOR
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7THFLOOR
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:
(Print or Type) Check one: Certificate
Installing Company Name 6�ma-y'dy Rud •l"wo, (� Corp.
Address T V Partner.
"'Firm/Co.
Business Tele hone
Name of Licensed Plumber: PA �Ilt 0V
$. .
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnity Q Bond
Insurance Waiver: !, the undersigned, have been made aware .that the licensee of 1 --
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner Agenf\•
I hereby certify that all of the details and information 1 have submitted (or en(cmd) in ahavc application ate true and s We to Ute be of Illy '• .
knowledge and that all plumbing work and installations licrfotntcd under Permit i t%ucd for (his application will be in eomptianee with all palinept pro. ;d
wisions of the Massachusetts State Plumbing Code and Chaplet 142 of lite Ccnual Laws.
'-W
By
Title.
City/Town:
APPROVED TOFFICE USE ONLY)
nature of L censed Plumt�e�c
Type of Plumbing License
License Number Q Master ,Journeyman
Date. -/My;
`# 3472 /
TOWN OF NORTH ANDOVER
...... o
p PERMIT FOR PLUMBING g
SSACMUS� v}
This certifies that .y.y!/:P-.N -'-. G !R ... /P,./ -� ........
has permission to perform ..lr A/C 0...w C. ..............
plumbing in the buildings of j>pL v.i I ....................
V3
at. .... North Andover, Mass.
Fee. Lic. No.. /.'VA . ... .........
PLUMBING INS CTOR g
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Office . The Commonwealth of Massachusetts Uy
�_�Use Only
� b .
t. Permit No.
Department of Public Safety / .e
ed
an_
=� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy & Fee Check
3f90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Ao wont to tw Wortnea in accordance min Me Mausct+u"= F"et"al Code. 527 CMR 12--oo
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date
ki _ _-4-2 11 - .,,/a,.�i _ To the Inspector of Wires:
City or Town of f of ► 'f
The undersigned applies for a permit to
the electrical work described below.
)-++,_ i " N-4 r
Location (Street & Number) w
Owner or Tenant t.v
dd off
Owner's Address
is this permit in conjunction with a building permit yes ❑ no (Ch -;k Appropriate Box)
Purpose of Building �/ C llr:L�/f 6t d Utility Authorization No.
Volts Cverhead ClUndgrd ❑ No. of Meters
Existing Service _�mps._J
New Service
Amps �(u Vcits Overhead ❑ Undgrd kms' No. of Meters i
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical War ' TOTAL
I
Cutlets I Na of Hat Tubs 1 No. of Transformers KVA
No. c. lighting..utlets Abcve {- -I in r--
No. of Uahtinq Fixtures 15wimmina Pool erne. crud L
Generators KVA
No. of Emergencl Lignting
No. of Receptacle Outlets
INo. of Cil Burners Battery Units
No. of Switch Cutlets I No. of Gas Burners FIRE ALARMS No. of Zones
TOTAL No. of Detection and
No. of Ranges No. of Air Conditioners TONS Initiating Devices
HEAT TOTAL TOTAL No: of Sounding Devices
No. of Disoosals No. at Pumos TCNS KW No. of Self Contained
Detection/Sounding Devices
No. of Dishwashers Soace/Area Heating KW
Municipal
Heating Devices KW Local ❑ Connection []Other
No. of Dryers Low Voltage
No. at No. of Wiring
No of Water Heaters KW ISicns Ballasts
No. of Hvdro Massage Tubs INo. of Motors Tctal HP I
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements et Massachusetts General Laws
I have a current Liability Insurance Polio y ding Comoleted Operations Coverage or its substantial equivalent. YE NO ❑ I haave submitted
valid proof of same tat otfce. YES NO CI
It you have checked S, please indicate the type of coverage by checking he acpropriate box.
INSURANC 8ON0 ❑ OTHER ❑ (P!ease Specify) (Expiration Date)
Estimated Value of Electricat Work S
Work to Stag
Inspection Date Requested: Rough . Final
Signed, under the penaltiessat perjury: LIC. NO /,---
FIRM NAME-4,6f-&'12�Li�!���/
//11 ��NO------
Licensee
NO._
Licensee CiNo �.�-� - Signature
Sus. tel. No.
Address
Alt. Tei. No. aired by
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage ar its substantial equivalentscheck
as reg
Massachusetts General Laws, and that my signature on finis apptication waives this ;;;7n, Owner Agent (Please check one)`
Taieoncne No•
PERMIT Fc: S_�'1
M
so
r L,,,- � . « f ...-y� - _T .�.�.r-.ti; fir- +..vF3'�-�-.-...a r '...--+t • -�. ,..�
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.
i
2906 Date ........
41W.-
TOWN
,..TOWN
OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .....G.a `V Q t°.. f /��.. c f � • .. I/ (J'
................................................................................
has permission to perform ....... `Q' :..2..... f ..J.l.�`J� c.` .............
wiring in the building of Z� .......!.. �.. J
....................... ...P..... .....%.......
at ..... /,.X)l...7........�`q �.wuod .. v �............. . North Andover, Mass.
Fee.aA.: d v...... Lic. No. f..� ,.............................................................
fELECTRICAL INSPECTOR
WHITE: Applicant CANARY Building Dept. PINK: Treasurer GOLD: File
Location ? r—o iC CVMQ4
No. Z- �� C--- Date Z�
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
,ether Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
c< ?11/94s�
42/09/% 12:48
9548
wilding Inspector
25.40 PAID
Div. Public Works
Locati Q he
No. i Z Date
sJ�CHUSE�
i
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
1 / 14;12
1,M-00 PAID
9281
(V")
Building Inspector
Div. Public Works
Location
No. ZS Date
i
F � �
A;= 9280
Lot `P
a
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ 6--D '.;-
Building/Frame Permit Fee $
Foundation Permit Fee $ t (DQ
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ 5�
Building Inspector
Div. Public Works
.. .. � „ , _moi t .. 'a �.. rq-.✓�-`.. ./ _ _ �..._//'"`7^,_:
Location 8,%'t"Dryc��1 T (0
No. Z Date -16
FY Water Connection Fee $ 4,n77, 5d
TOTAL $ 67 J
P
Inspe tor`
8963 Div. RUEWC70rks
AORTN
TOWN OF NORTH ANDOVER
3?o'tf� !• '��c
�;
..
Certificate of Occupancy $
+#
BuildinglFrame Permit Fee $
Ac
Foundation Permit Fee $
a
Other Permit Fee $
Sewer Connection Fee $
FY Water Connection Fee $ 4,n77, 5d
TOTAL $ 67 J
P
Inspe tor`
8963 Div. RUEWC70rks
PER111T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGE 1
N4AP K40.
LOT NO.
I
2 RECORD OF OWNERSHIP (DATE
BOOK 'PAGE
ZONE
SUB DIV. LOT NO. 7� P
1
I
LOCATION
2
PURPOSE OF BUILDING
OWNER'S NAME OL
`f1 NER'S ADDRESS /�
ARCHITECT'S NAME
6
,
4e af
NO. OF STORIES SIZE
'Vil e tt W �� 2. 44
BASEMENT OR SLAB
�aS-r°� � vT
SIZE OF FLOOR TIMBERS IST 2 z) 2ND � �// D 3RD
4.[ A
Bla1LDER'S NAME V � a-
_1 a / / ,r
C�
Q�/1
SPAN
DISTANCE TO NEAREST BUILDING
e\
[/
DIMENSIONS OF SILLS �x
DISTANCE FROM STREET
T�1�
"' POSTS
DISTANCE FROM LOT LINES - SIDES
REAR v
GIRDERS �/ 2
AREA OF LOT �i ^ / _
/JAI/
C �.�+FRONTAGE /
HEIGHT OF FOUNDATION II THICKNESS / }I
V
IS BUILDING NEW
j
SIZE OF FOOTING X
IS BUILDING ADDITION �() D
MATERIAL OF CHIMNEY s,
IS BUILDING ALTERATION
A'
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE s
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE Ys
INSTRUCTIONS
PERMIT FOR FOUNDATION ONLY
SEE BOTH SIDES REGULATED BY PARA. 114.8-S. B.C.
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12 DATE CFEE PAID -ICo -_
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
-b
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
SIGNATURE OF OWNER
F -E E 1.4
PERMIT GRANTED
to ,9
DATE: L d FEE
3 PROPERTY INFORMATION
LAND COST 75-7 ey��
EST. BLDG. COST���71 �,c��� v���je
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO. �J
4 APPROVED BY
OWNER TEL. #
CONTR. TEL. # �! 112
CONTR. LIC. #
H.I.C. #
st' 63
c,Z80 ?�I9
ctm at4rA ��
1 OCCUPANCY
SINGLE FAMILY SiOk1E5 _
MULTI. FAMILY OFFICES _
` APARTMENTS
CONSTRUCTION
2 FOUNDATION 1�11 8 INTERIOR FINISH
CONCRETE d 1 2 0
BUILDING RECORD
12
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. +
DRY WALL
UNFIN.
'
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���}�"�•>Io
3 BASEMENT
AREA FULL
FIN. B'M'TAREA
_
14 1/2
FIN. ATTIC AREA
NO BMT
FIRE PLACES
T
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HEAD ROOM
—
MODERN KITCHEN
4 WALLS I
9 FLOORS
CLAPBOARDS
DROP SIDING
B
_
1
22 J
—I—
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_
CONCRETE
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
EARTH
HARDVJ'D
COMMCN
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON -MASONRY
BRICK+ON FRAME
ATTIC STRS. & FLOOR _
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I�dPOOR _
ADEQUATE NONE
5 ROOF
GABLE HIP
GAMBREL MANSARD
FLAT SHED
10 PLUMBING
BATH Q FIX.)
TOILET RM. (2 FIX.)
WATER CLOSET _
ASPHALT SHINGLES
LAVATORY
_
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
_
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
WOOD JOIST
I 11 HEATING
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. 6 COLS.
STEAM
STEEL BMS. 3 COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
_
RADIANT H'T'G
7 NO. OF ROOMS
UNIT HEATERS
GAS
OIL
B'M'T 2nd _
Isi T3rd I
ELECTRIC
NO HEATING
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
_3�s X % r Phonei�APPLICANT: dol?
LOCATION: Assessor's Map Number Parcel
Subdivision �OX��It�D� Lots) (o
Street li o d d 1/f- I v 2 St. Number_
************************Official Use Only************************
RECOMMENDATI PS OF S: qq
Date Approved Ad� `S
Conservation Administ ator Date Rejected
Comments
Town Planner
Comments
Date Approved
Date Rejected
Date Approved
Food Inspector -Health Date Rejected
Septic Inspector -Health
Comments
Y
Date Approved
Date Rejected
Public Works - sewer/water connectionsj�t,J
- driveway permit !p- l'6 -%S'
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A.t/OOYEA ; �1.4S.S.4C.fil/SETTS O/8/O
EC
COLLOPY ENGINEERING CONSULTANTS
65 AYER STREET METHUEN, MA 01844
FRANCIS H. COLLOPY
REG. PROFESSIONAL ENGINEER
Mr. Dick. Tobin
Foxwood Realty Corp.
733 Turnpike Street
Suite 311 N
No. Andover, MA 01845
Dear Mr. Tobin:
w�u
Residence: (508) 685-7969
Office: CIVIL
(508) 685-8069
STRUCTURAL
Fax: N
DYNAMICS
November 28, 1995
I am writing relative to the existing foundation at Lot 6 on
Foxwood Road in No. Andover, MA. I inspected the site on
November 27 with you for the purpose of providing my opinion on
what should be done to repair the 1/2" wide crack in the garage
foundation which recently opened near the right front corner of
the garage. I have shown the location of the crack on the
enclosed engineering sketch of the garage floor area. This crack
occurred in an area where the fill on the inside of the garage
was approximately the same height of the surrounding ground
level. This is an unusual location to get a crack in a foundation
wall. You indicated that it probably could be attributed to the
compaction equipment which was used to compact the soil in the
garage in recent days. This provides a very logical explanation
since the unbalanced soil pressure is practically negligible.
This crack can be properly repaired by an approved applicator of
a structural epoxy product known as Sikadur Epoxy Resin. This
company, manufactures a number of products for this kind of repair
where you want to prevent leakage and to restore the structural
integrity of the wall. The product which I believe is best suited
for your repair work is "Sikadur 35, Hi -Mod LV". This is a high -
modulus, low -viscosity, high strength epoxy grouting, with a
sealing & binder adhesive. This material is pressure injected
into the cracks in a systematic fashion so as to guarantee a full
depth repair.
I know of two such companies which specialize in this work, and
with this product line, namely:
Jager Construction Wayne Fortier
P.O. Box 325 Crack -X
Amherst, N.H. 03031 So. Natick, MA
1-800-722-0768 1-800-548-3379
1-617-235-2389
Upon inspection of the actual crack to be repaired, the Sikadur
contractor may recommend another similar epoxy product. It is my
understanding that each of these companies stand by their work
with a guarantee. There is a loose section of concrete wall
which should be removed and replaced, as indicated on the
enclosed engineering sketch sheet, prior to the crack repair. The
new section should be connected to the existing wall at the cut
line with epoxied dowels.
It is my understanding that your intent is to construct your slab
as shown on the attached sheet, utilizing a mat of reinforcing
rods in the slab, so as to connect your slab to the rebars which
are in place and which will project out of the existing wall.
This is meant to provide a tension tie across the garage slab,
and minimize the effects of any outward pressure. There is very
little such pressure in the vicinity of the existing 1/2" wide
crack, and after the repair with the proper epoxy product, the
wall should be acceptable for use.
If you have any questions concerning this matter, please do not
hesitate to call this office.
Sincerely,
COLLOPY ENGINEERING CONSULTANTS
Francis H. Collopy, P.E.
Structural Engineer
Attachment
COLLOPY
ENGINEERING CONSULTANTS
65 Ayer Street
METHUEN, MASSACHUSETTS 01844
(508) 685.8069
POO 0-04-5
JOB fOXX W vo D %L E p L 7 -
SHEET
SHEET NO. / 6F
CALCULATED BY F!� L DATE
CHECKED BY DATE
,¢.t.6.419. -_s .....
KAREN H.P. NELSON
Dinvor
BUILDING
CONSERVATION
HEALTH
PLANNING
DATE
�.-
• NORTH .ANDOVER -
PLANNING & C0NmUN= DEVELOPMENT
CHIMNEY APPLICATION AND PERMIT
LOCATION GUC
OWNER'S NA14E
BUILDER'S NAME /"ir
MASON'S NAME
120 Main Street~ 01845
(508) 682-6483 - ... .
PERMIT, Z�
MASON'S ADDRESS w` '
S TELEPHONE
MATERIAL OF CHI:,11lE':
INTERIOR CHIMNEY Or EXTERIOR C i LVEY �iiJ .
NU14BER AND SIZE OF FT. -
:HIC: LESS OF HEART1,i //a
Wi'_'_ cn;-nev or to require eats of the code and
have rules apdred •latio::s --e=n received:
DATE
SIG,+ATURE OF MASON _ CO'3TR. LiC. = 111A-
.:Crc^+ = 'COTRC PRI CONSTRUCTION COS.
PERI.IIT GRJ�IITED
ROBERT NICETTA, Bi:ILDI_:G -i S EC' -OR
INSPECTED
REMARKS
FEE
c --� 3viCr REQUIRED
THIS PE-R-`4IT :MUST BE DISPLAYED ON THE PRE IISE S
CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number_ 525 (193j) Date T_ uNE 99h
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 87 FOXWOOD DRIVE (Lot #6
MAY BE OCCUPIED AS _ SINGLE FAMILY DWEIIING W/ CAR IN ACCORDANCE
GARAGE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TOFoxwood Realty C-
733 Turnpike S
ADDRESSNorth An ve i
,'�ACNt15�
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