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Miscellaneous - 894 GREAT POND ROAD 4/30/2018 (2)
N OO Date. ..... 4' TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION, This certifies that ................. has permission for gas iAgallatiOn ......... in the buildings ofe- . ............................... at .... .......... ...`:.`4... . P.4.,%gNNr t h nd Mp Fe4V� Lic. No.)' 1.tL. AS SINSPECTOR Check # h19 8253 9488 TOWN OF NORTH ANDOVER PERMIT .FOR PLUMBING This certifies that ... ... . has permission to perform.. �? 0 f plumbing in the buildings of . ................. "' a i . 121. at .... Q,-1 �....... (� CAAUMBING . orth Andove Mass. Fee. . Lic. No. �."9.... INS CTOR Check # SIR MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �' _ aL, MADATE_ �"' PERMIT # - JOBSITE ADDRESSVNER'S NAME�� _ POWNER ADDRESS _ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIRCR2?-, PRINT CLEARLY NEW: RENOVATION: REPLACEMENTS PLANS SUBMITTED: YES NOD FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM ! DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I __.__.._..( .._......___i E ._.__.-..J ..._._.._.i I ._...._.._._( J .__._� __.....__...( _._..._ ( ____._.! _-_ (--_---[ DISHWASHER DRINKING FOUNTAIN (.___....._( I _._____` FOOD DISPOSERJ ____j ...... FLOOR /AREA DRAIN INTERCEPTOR INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN ._.. _ 1 SHOWER STALL ___._. SERVICE / MOP SINK _J -- _-( --.___i TOILET TOILET I .___.._.. i ..__ .__. _.__I ____-.—i _._._._.._j _I ___.__I URINAL i .._ I .I __.._._ i ...__.__ { ._... _..1 _..... ..( ___ .._ f -__- _1 .__ ._._J ._....__._ . ('....___i .----- ---- _. WASHING WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES _I I f _. f -- __-! __--( 1 ( _..__ _ _1:._ .._. ...�__I _I WATER PIPING OTHER _ ..._, - 4 _ --- ► _! ._._....---�-._-.._.._1 I (._._..._..__..(---_.---_! ....__.___i _._. f :..--( --J --- ( - -l ' a INSURANCE COVERAGE: 6 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES []_I NO Q OF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE PO OTHER TYPE OF INDEMNITY D BOND Q OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT I SIGNATURE OF OWNER OR AGENT R hereby certify that all of the details and information I have submitted or entered regarding this application are tr and a curate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co eminent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME �_ �,eS-LICENSE # SIGNATURE IVIJP0 CORPORATION[]_ I# - -tPARTNERSHIPO#=LLC COMPANY NAME j&- j,1 C y,J ADDRESS SSG/ S G CITY t� �/ ]STATE ZIP�s�-�.^1 TEL FAX L CELL I EMAIL 4 41 F=, LU Lij LU LL The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 awww mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Address: ZY Cm/s r7'T— G-/ City/State/Zip; `M_ Phone Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I aM loyees (full and/or part-time).* have hired the sub -contractors a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3111 am a homeowner doing all work myself. [No workers' comp. insurance required.] t 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. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day aga' violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the _DKfor inXurance coverage verification. I do hereby c�fy under pains and penalties of perjury that the information provided above is tree and correct e - Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of ,this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK x CITY1//7_Jy _I MA DATE - o- . Z PERMIT # JOBSITE ADDRESS OWNER'S NAME GOWNER ADDRESS TEL— FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL D] RESIDENTI CLEARLY NEWT -1 RENOVATION: E-] REPLACEMENT. PLANS SUBMITTED: YES E-11 NOEJ APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 S 9 10 11 12 13 14 BOILER a I BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER -- - { DRYER FIREPLACE FRYOLATOR I. _— _ _ T _ _ - FURNACE - ...= - L. L _[771 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES JE] NODI IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Ej BOND F OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are tru nd a curate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comi ce it all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME�� LICENSE # s7" I SIGNATURE IM GF El 'JP Ej JGF a LPGI I CORPORATION D# L J PARTNERSHIP 0#= LLC D# COMPANY NAME: ADDRESS r CITY _ _ STATE ZIP Q o2!T ]TEL FAX CELL -�MAIL W H °z 0 H U W a 4 w • y Z O N ❑ W F- W [O a w z W � CO � W 5 pa ® w a W W w N ZO W a a a � �y U J ' E., a a Q U x E w w L W H I °z ! H W ' C7 - x The Commonwealth of Massachusetts Department of IndustriqlAccidints Office of Investigations UT 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Orga Address: City/State/Zip: hh LXJW,,,, 01932 Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* have hired the siib-coritraotors 2�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. ❑ I am 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.] Type of project (required): 6..❑ New construction 7. E] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new 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. Below is the policy and job site information. 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 requiredunder 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 Ike violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D or ins ante coverage verification. Ido hereby ce i under t pains and penalties ofperjury that the information provided above iss true and correct. Simature: Date: 6 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Coremonwealth. of Massachusetts Department of Industrial .Accidents Office offnvestigations 600 Washington Street Boston, MA 02111 Ted. # 617-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fax # 617-727-7749 wWwanass,gov/Glia I ce '771 N. W=JM4 'CL Cl) f[m LU Cl) < LU z ol LL Zi (En D cn w 0 > o Z 0 < C/) Ln CD Ld LU aa jLli z 0 - LWU CL z LU co REGISTERED STRUCTURAL ENGINEERS MEMBER: ASCE, SEI, AISC, ACI, CSI MASSACHUSETTS 08669 NEW HAMPSHIRE 01196 CENNECTICUT- 07487 NEW YORK — 37301 VERMONT 02009 MAINE 01519 CI �D. PROFESSIONAL ENGINEERING SERVICE SINCE 1958 . PROJECT: % qH G rea-t�itY9 Q. No, A ✓ d oven ly A CLIENT: —root cil DENCO ENGINEERING STRUCTURAL ENGINEERS 145 F'AHK `J 1 KCt I NORTH READING, MASSACHUSETTS 01061 (978) 664-6753 FA:! (978) 664-923:1 PROJECT NO.: 003 - 0'4 BY: a(AJ.S DATE: REVISED: REV. DATE: SUBJECT: LVL. O M" I V to 3 @2004 DENCO ENGINEERING HEET NO. OF 3 (� / LVL Lorid = 56 3 tuft' 'l, Sp:vl = 19 ft" stca ner ed - a L oct = 50d), lb spay) 5 ft Reuc ion§ = ;L 531 146 S �► eat Ve fter ; rjv) = 0.1 i .K. omolo at+ Ab.tm REGISTERED STRUCTURAL ENGINEERS MEMBER: ASCE, SEI, AISC, ACI, CSI DE CO ENGINEERING MASSACHUSETTS 06669 NEW HAMPSHIRE 01196 STRUCTURAL ENGINEERS CENNECTICUT -- 07487 NEW YORK — 37301 148 PARK STREET VERMONT 02009 NORTH READING, M.ASSACHUSEI-FS 01864 MAINE --_- 01519 (978) 664-6733 FAX (978) 664-9233 PROFESSIONAL ENGINEERING SERVICE SINCE 1958 PROJECT: Z94 G /p Pond /ted , PROJECT NO.: 003 clI a� Arl vifiew ,,, /'u BY: OW5 DATE: 3 CJ CLIENT: "rrj REVISED: REV. DATE: SUBJECT: LVL Q Bea ID e51 EiLn @2004 DENCO ENGINEERING SHEET NO. �' OF 3 SPwn = I S fr 5/� - I I , a5 f i p 273 g75 16- ih . H X)2 OF 8pow, z 437.7 i �3 50 l7i�k )L = 73,,g l y)3 KENNET" pEA/NiSOd, 1Z ` m QI V1) V1. yr J ix- M7,7 / i �1 7 3. O w STIRUCTURs,,v ., iln ldg, °! 8 `l 870 119-1y)_ _ 'Srij b- t i - -2072• s to- r I g " I sg 5o Ib --pal; 3 ����$ LVL �3 ;h3 ci Z5 11/i ►�� DENCO ENGINEERING STRUM URAL. ENGINEERS PROJECT: 9 9 ( Gr eq l' POn d W, PROJECT NO.: �Du)-5 0 0 3 � oq �1 V Y` A BY: Du)- +c DATE: I/ CLIENT: p h ! i S REVISED: Q REV. DATE: SUBJECT: L VL B eawi DPS J cLvl 0 2004 DENCO ENGINEERING SHEET NO. OF C s� ✓ oK L 5662 P � � M ✓ �O��I�J fib. �:9�a P �J II1 X 30.07 3 v Lt �, X 10 .17 ✓ o� SIO 340 `K,o KiMNETFi >f.. ,�� Dva{SoN ',tr 40. "So STM)aUftat, a ' is .�._ �t Date ..l/1 ............... 1 !NORTH 1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING . o,_ to ,•' , v f // This certifies that .... � .. .. Zliz�Kt& has permission to perform�� �� �% / ` / t'/f e z ... .r.......... wiring in the building of ....!:.:J. f %/ -..... ...`..: . .............................. �... .....� at .�?:lei.1...I.:.<-.:%�.....�...'!f.... North Andover Mass. Fee....Lic. No. j%� .... ............................................................ P ELECTRICAL INSPECTOR Check # 1022 THECOAIUfONWEALTHOFIVASSACHUSETTS. Office Use o��y.��` DEPART[YfVT0FPUX1CS4FEIY Permit No. BOARD OFFIREPREVM.IONREGUTA7IONS52 ggl2:(,10 Occupancy & Fees Checked v v APPLICATION FOR PERART TO PERFO MELECTRICAL WORK ALL WORK TO BE. PERFORMED IN ACCORDANCE WITH TRE M ISSACHUSSTS ELECTRICAL CODE,. 5.27 CMR -12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date of f1 Q.L Town of North An M To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. . Location. (Street &Number) W z�;TAI %gid Ap4d /VQ 1,w WA Owner or Tenant Owner's Address ii `q &'fe g r M^4 AdAzy NU ,OKt A-tek-,fle Is this permit in conjunction with a building permit: Yes �o No (Check Appropriate Box) ` Purpose of Building e5i jiE'+ 4; a, 1i Utility Authorization No. Existing Service AmpsVolts Overhead Underground.. No. of Meters New Service Amps / Volts Overhead Underground No. of Meters_ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Uri 510AM` m fen o a 77 No. of Lighting Outlets No. of Hot Tubs 1: stun RUt , ,IN" ted Vadteofau" W ik $ No. of Transformers Sigtted undo '&P tries Total No. of Lighting' Fixtures Swttnming Pool Above Below ! Generators - /3%/9Z KVA KVA - round round lio=No , ie3 % 7— No. of Receptacle Outlets No of;0il Burners No. of Emergency Lighting Battery Units No. of Switch Outlets 'S 0NrINSURANCE WAIVEI; ; I am aware thatthe Umse does not have the irm,ruxe wA V exits a6t, al ial equivajent as t 4iwd byMmmdusells C,t mw Laws afYl that my 9gnalWe On (hlSpElITll[ i�Jp}lgflCXl Wai1�S (lits 1H�11IE1T1�Y. . No. of,Gas Burners FIRf-_ ALARMS No. of Zones No. of Ranges No. of "Air Cond. Total .L. Tons No. of Detection and No. or Disposals No of Heat T%otal 'row :;Pumps Tons. -. KWIniliating Devices . No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding. Devices Local Municipal EJ Other No. of Dryers Heating. Devices KW Connections No. of Water Heaters KW No. of No. of Signs-, .. Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER � r L 'yixia'i.G lA/YfJ[I '�, rlLWdIIU II�Rx�f'7JI�Q1V1a�i1�i1t$iJeilEidt13w$ .' -.. IhawaamoltLmbt74ykwmneeFb yir idngCanpleoe C0erworiisstib6wWecpir" YES[71:NO. IhaveatxnotedvatidpocafofsarrlebtheOff= YES If)aikiyf drdodY[s,plseixic* het)peofcovaageby dWd%lhebox INSURANCE BOND OMER RED (P1eaw SPAY) _ 9%C oO Wotk6oStait � Q htspocnalD Reclttesuxl 1: stun RUt , ,IN" ted Vadteofau" W ik $ Sigtted undo '&P tries FIRMNAME e L✓.4�e C Se %L' LioatseNa - /3%/9Z ` Lim.//I obiP�' !%, /T��✓ii e Signature : - ¢ lio=No , ie3 % 7— AlTe1 Na 'S 0NrINSURANCE WAIVEI; ; I am aware thatthe Umse does not have the irm,ruxe wA V exits a6t, al ial equivajent as t 4iwd byMmmdusells C,t mw Laws afYl that my 9gnalWe On (hlSpElITll[ i�Jp}lgflCXl Wai1�S (lits 1H�11IE1T1�Y. . (Please check one) Owner Agent: i Telephone No. PERMIT FEE 00 -Signature ol uwner or Agent The Commonwealth of. Massachusetts Department of, ndustrial Accidents Office. of'ln�estgations Boston, :Mass `02111 Workers' Compensation Insurance Affidavit Address J 1;1 ,011M City: L�lellee Phone # Insurance. Co. ,1 5 .t " . za e Polia # u� Compgny name: Address city: Phone # Insurance Co. Policv # Failure to secure coverage as require: under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine vup to $1,500.00, and/or one years' impnsorrrmxrt as_*tWLas.civil.penaltiesmlhei�n�fa-STOP 1VORKDRDERar�d.a finedA31MM aiday.agairsstme. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certdy under the pains and penalties of penury that the information provided above its true and correct Signature _Date — t Print name Phone.# r Official use only do not write in this area to be completed by city or town official' City or Torun Permit/Licensing Building Dept pCheck if immediate response is.required .0 Licensing Board El Selectman's Office Contact person: Phone #.--E] Health Department 0 Other. Date "OR'M TOWN OF NORTH ANDOVER O`�o ,ti00L PERMIT FOR PLUMBING his certifies that has permission to perform .... E'.y ............................ plumbing in the buildings of ..l.? !'. `:..................... . at .... . `i Vii.. . !1. '. �� f . ..... , North Andover, Mass. Fee. ``. . . .. Lic. No.. !'.G. G .'. ? . ...... ':...... :_.. PLUMBING INSPECTOR Check # 3 MASSACHUSETTS U (Print or Type) /-/ 2N� v , Mass. J Building Locatio New ❑ Renovations ,RM APPLICATION FOR -PERMIT TO DO PLUMBING Date 4 20 0 7 Permit # wner's Name�,� Type of Occupancy_;, Replacement ❑ Plans Submitted: Yes 0 No ❑ Installing Company Name -_�`/ _ �� � j v P14 Address c2�l�d•/,�,./ �� /040 Business Telephone Name of Licensed Plumber or Gas Fitter SEPTIC # Check one: Certificate ❑ Corporation ❑ Partnership �/�i �irm/Co. Ad 70/, G INSURANCE COVERAGE.... I have a cur+n Ility insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142, Yes No ❑ If you have checked ves, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. signature of Owner or Owner's Agent Check one: Owner 0 Agent 0 I hereby certify that all of the details and information l have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed undo a permit issued for this appli tion will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Ch ter 2 he Ge Law By Title Signatur f License Plumber City/Town APPROVED (OFFICE USE Type of License: aster ❑Journeyman License Number �G► /� FIXTURES B.P. # SEWER # Ir SUB-BSMT V) Q U) Z CJ Cn > In Q Q p =M V) W W _ ~ �a �- Z _ Z Z Q z � ¢ Y LU O Ln Y Z Y CL C) Z p q d F— to BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name -_�`/ _ �� � j v P14 Address c2�l�d•/,�,./ �� /040 Business Telephone Name of Licensed Plumber or Gas Fitter SEPTIC # Check one: Certificate ❑ Corporation ❑ Partnership �/�i �irm/Co. Ad 70/, G INSURANCE COVERAGE.... I have a cur+n Ility insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142, Yes No ❑ If you have checked ves, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. signature of Owner or Owner's Agent Check one: Owner 0 Agent 0 I hereby certify that all of the details and information l have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed undo a permit issued for this appli tion will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Ch ter 2 he Ge Law By Title Signatur f License Plumber City/Town APPROVED (OFFICE USE Type of License: aster ❑Journeyman License Number �G► /� Dated-. L ...... . NORTH °F ao '6 TOWN OF NORTH ANDOVER t PERMIT FOR GAS INSTALLATION This certifies that . ���..f�.w.N.� .�. �.... �'. has permission for gas installation .... F ?1!! .7.: ! ............. in the buildings of ... �,u9. !� �. at .. rF`?. t.f.. r1 �' ` . �..1 �! .... ....... , North Andover, Mass. Fee. 3P.'".... Lic. No. /0 i� ?.'... ..... C4 ?.-n ... . GAS'INSPECTOR i Check # 76.7) 4627 C - MASSACHUSETTS UNIFORM �(Print or Type) 1. Mass. Da, TION FOR PERMIT TO DO GASFITTING ; V r 20Permit d Building Location b- y -A , Owners Name :2r-1tl/- Type of Occupancy Newig; Renovation ❑ Replacement❑ Plans Submitted: Yes ❑ No ❑ 1>Q Installing Company Name JL i"AAo A&,p Pk- Check one: Certificate Address j�,l//� A.1 ❑ Corporation Business Telephone _ �� ❑ Partnership Name of licensed Plumber or Gas Fitter Q 6� �/FirmACo. i INSURANCE COVERAGE: I have a ces n Iabllity Insurance policy or Its substantial equivalent, which meets the requirements of MCL Ch. 142. /� Yes( No ❑ .If you have checked yes, please Indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit lication waives this requirement Signature o wner or Owne s Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of my knovMedge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts state Cas Code and Chapter 142 of the Ce Type of license: By ❑ Plumber SVrAftre of Licensed Plumber or Gas F Iter Title ❑ Cas fitter City/Town �Mast:er Lkense Number �� d APPROVED (OFFICE USE ONLY) 0 Journeyman • s a :. s • MM MMM MM sMMMMMMMM ais ■ M MMM M MOM EM . e.- PC] R. e e ' Mo MMME M��������� I-INNAKeTel,M M MMMMMMMMM M ON� . e ' mmmlmmmmMmmmmmmmommm 1>Q Installing Company Name JL i"AAo A&,p Pk- Check one: Certificate Address j�,l//� A.1 ❑ Corporation Business Telephone _ �� ❑ Partnership Name of licensed Plumber or Gas Fitter Q 6� �/FirmACo. i INSURANCE COVERAGE: I have a ces n Iabllity Insurance policy or Its substantial equivalent, which meets the requirements of MCL Ch. 142. /� Yes( No ❑ .If you have checked yes, please Indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit lication waives this requirement Signature o wner or Owne s Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of my knovMedge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts state Cas Code and Chapter 142 of the Ce Type of license: By ❑ Plumber SVrAftre of Licensed Plumber or Gas F Iter Title ❑ Cas fitter City/Town �Mast:er Lkense Number �� d APPROVED (OFFICE USE ONLY) 0 Journeyman Location S ! (Zn4 -�ON `o No. o Date TOWN OF NORTH ANDOVER s L A Certificate of Occupancy $ s�CM�s <�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # F \ �i 1/003 j o► A, A ( Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �...: � :�� n ,� ��s�x� �s �'',� a ° �yy�• ,,max �.� s �� e. BUILDING PERMIT NUMBER, DATE ISSUED: � SIGNATURE: Building Commissionerlq for of Buildings Date SECTION 1— SITE INFORMATION ', e 1.1 Address: 1.2 Assessors Map and -Parcel Number: �Prroopertry ei/ jONJ�.2,2, AWPAVV Map Number Parcel Number 1.3 Zoning lttfotmation: 1.4 Property Dimensions: '+oo mac. Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water Supply M.G.L.C.4b. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public = Private ❑ 'Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT 2.1 Owner of Record L,AcLR.i� I'mkL; eg4- 099K -figap � *a P Name (P 'nt) Address for Service: ngn ture Telephone 2.2 Owner of Record: Narrlre Print Address for Service: Si nallare Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: , Not Applicable , ❑ ' IMM A6 Of Cott .5 Licensed Construction Supervisor: Q 7 i/t4jo(`� / IT pr }� / ti/ License Number �41 , / 2 �✓ l/���f Q� L108-0 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name _ � J, L Mrs" Registration Number Addr s om o 3 �Z 191O�G Expiration Date Si nature Tele hone MU M z O v r Q O z M 90 O r M r z G) SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Description of Proposed Work check allapplicable) New Construction ❑ Existing Building 0 Repair(s) 0 Alterations(s) , Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description Work: �q � ��J Zj PMI VL-' {/>S� 1 LIQ• 2 SECTION 6 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b ennit a licant OFFICIAL,USE�ONLY r A x 1. Building(a) (200 Building Permit Fee Multiplier 2 Electrical(b) `off vW Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) O 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize 0. awGp,% to act on My beha n all matters ve to w kauthorized by this building permit application. a e of Owner Date SECTION 7b OWNERAUTHORIZED AGENT DECLARATION 1, I ,as Owner/Authorized Aaent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief �S 03 04- Siat e of vn ent Date ., Miami NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DfN ENSIONS OF POSTS DIMENSIONS OF GIRDERS 11EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHPVINEY IS BUILDING ON SOLID OR FILLED LAND 1S BUILDING CONNECTED TO NATURAL GAS LINE w� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation insurance Affidavit Please Print lr'; 17. r 1(_ I am a homeowner Wfarming all work rfiyself. I am a sole proprietor and have no one worldng in any capacity 00 1 am an employer providing workers' compensation for my employees working on this jots. Company name.��s COATI ". Address city. A49*14, tr• _ POLO Phone *7 50 v''4m�� 6AZ27 Insurance -Co. Paicv #W CZ'J13-32381 - �l7_ Company name: Address . Failure to semen coverage as required under Section 25A or MGL 152 can legit t*the imposkion ci c�mmat Pte: of axfihe up �.i andfor one yeah' imprisorrr enter X047 peva S�lbeSams�f��JOF foe�f (S7QA ODj� yr�3 t understand that a copy of this stent may be forwarded to the Office of Investigations ct the DtA for c&4erage WrificWori I do hereby 7� ftpefUpfts of perjury hW the k&m7aft,7 provA*d above is true and c'oaft-L Print Official use only do not write in this area 6 be compieted by city a town offtiar City or Town D Other North Andover Building Department Tel: 978-688-9545 DEBRIS � DISPOSAL. FORM I - -- ' In "accordance with the provision of MG,L c�40 S 54, a condition of Building Permit Number is that the debris resulting from`thisfwork�sh'all be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of 'in:-- - (Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ^t i you vrt � t � 1ei e•.. v, .[/ � � iw / vim,+✓.+. ; �' —. = r hhvw INC • THIS IS A LEGALLY BINDING CONYRAC' F NOT LNDERSTOOD. SEEK LEGAL ADVICE LABOR—BUILDING CONTRACT ��is Agreement, made this (Jay o 14 .D / -by and :;ler weer? r • f o the firstpurl, u,,� of �� 0• G /Cav � �t U ecL Of 44z* Az?waz of the Jecond part, witnesseth: That the party of the frs: part, for t:he consideration hereinafter mentioned, agrees, wah the party of the second part to perform n? u fii'1 ful a,id workmanlike manner, rhe fo;lowrTlo speri :; J work, viz.. "ITY 5CvP 6* i0i 04- Lf Cvkrl�4.5 4, )c �LMIA4`C 1 M 04 - Alla :r? NU(p,-.,$; %d) ....,C: -c', rr: ...t.,. .+U`iil lalc' work which iS lfl LilllilT;" F, ,70aqv and to be compicted wid delivered. fret' friom a O i rA Cd o :a u z 0 u O L i! �aaqq O y 0 L L dam/ C O V _cc ZLCIO O O Q .7:= CO) C O v CM O C C12 cc CD co �O ® o L CL Q c� O O ♦0.. CD CLCOD c W D H W icoW i W W W H .0w u o w A cn O W A a w° a�' U w R. W Rr d id w 0 W m C2w 2 is 8 DID ro w W C CQ cin . o cn o :a u z 0 u O L i! �aaqq O y 0 L L dam/ C O V _cc ZLCIO O O Q .7:= CO) C O v CM O C C12 cc CD co �O ® o L CL Q c� O O ♦0.. CD CLCOD c W D H W icoW i W W W H 4 Q . i 40 O 2 goC ,H 1 r c .403 042 m CL COD � CO) C CD ce cc C C mo cac CLC.) cc c c ca Q m o .o 4c J:C433ho a cc 9Z 7 .. Q L-® � V. ca C O L- .o CL— ca N H C LLJC=L ��'v A is to W .E iz vov� Z co CD COD Q R ®� ®� ® yCD CL.N. cc ::Fp o :a u z 0 u O i! �aaqq O y 0 L L dam/ C O V _cc ZLCIO O O Q .7:= CO) C O v CM O C C12 cc CD co �O ® o L CL Q c� O O ♦0.. CD CLCOD c W D H W icoW i W W W H *N2 2218 NORTH 0 Date ........ 12 .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................. ...... zf: .................................................... has permission to perform . .................................... wiring in the building of ... ........................................................ ............. at Z':-�v.... . ................................................. .. North Andover, Mass. Fee ......... Lic. ...... .. .. ............ ............................. ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 7BE09W0AWE4L7H0FM YS4CHU ' 7`S' Office Use only DFPARTAMW OFPIIBLICSAFM Permit No. BOARD 0FFIREPREVEM70NRE9JL4T10M5r MR 12.00 Occupancy & Fees Checked APPLICATIONFOR PERAff TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date o lb Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 0` Pp PA C C3 a Owner or Tenant 10Q of Cl UCq Owner's Address /D kyy\ Is this permit in conjunction with a building permit: � Yes No (Check Appropriate Box) Purpose of Building t H f'�.00m r e rob Li ar%) Utility Authorization No. Existing Service Amps (ED/ FZ/LV olts Overhead Underground M No. of Meters % New Service Amps` / Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work `�� ©C3 0.ct 0 4:� 1 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 0 ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units f 1 No. of Switch Outlets i No. of Gas Burners FIRE ALARMS No. of Zones . of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP N QTHER huwceCo Ptastrattutheragtmar cfTvlassadus GentralLaws -- - - -- - Itmea=utLmb*lm==Pd y0udatgCaift Coaaecrilsubbab aPhda�t pNO IlMe%hnWdMW mtheOffe YES NO fjcuha%cdwdWYESpkmmdrae tyeefMWdgbyd xckigthe 11 11 bcx INSURANCEL' � (� ) f 6AJ OJ Wodc>D Start W I ft &, ValuecttE7tiral Wodc $ h Ve=! DateRixlu ed RoughFM fi- Sighed tn&M Pt s FIRMNAME Lioam �(�.U'I d Co p � oyu Sig. U �R�ti� li=wll-b f, 36c5 tt II p�� nq Blsate�sTd.Na �'1 9 " '� Aril= 'c; GJ'r U� /V f h ®I U Ai Na OWNER'SNSURANaWAIVMlanawatethatthet�oeasedo n ttremranewmWort&kMtalqt daiasm*medby GmrALaws aodfratrrryWmumcn tmpear>$app6rdtiarwdnesttmm*Ma rem (Please check one) Owner Agent a Telephone No. PERMIT FEE $ Date ..7.-. N2 4348 TOWN OF NORTH ANDOVER F PERMIT FOR PLUMBING ,SSACNUS� y f This certifies that % /.? fj`c • ....° ......... ........ . has permission to perform ... f?.(: y ............... plumbing in the buildings of 5 .. .................... �:'2 at ....?. North Andover, Mass. Fee . Lic. No.. f?,LUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 0 MASSACHUSETTS UNIFORM APPLICATION FOR PER � TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS 77 a l.44 p / j Date Building Location �7 ojy,/,/4 Owners Name�/ �/lEK �,� Permit # Lo k(? Amount New ® Renovations Replacement ® Plans Submitted Yes ® No Ej FIXTURES (Print or type) ��rr .� f Check one: Installing Company Name ��jC het%/D4�q A 17 Corp. Address A26Pf®%4` Partner s � N Business Telephone _ 0 Firm/Co. Name of Licensed Plumber: jVD AC -Z? 7'--�i l et/�-Oi✓s 0 Insurance Coveraee: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑- Bond Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ® Agent E] I hereby certify that all of the details and information I have submitted (or entered) in above applicat'on are true and accurate to the best of my knowledge and that all plumbing work and installations e�lodAe ndu or this application will be in compliance with all pertinent provisions of the Massachus to neral Laws. By igna ure 01 LIEFIRMum er Type of Plumbing License Title 4,0, City/Town is se um er Master)90"" Journeyman APPROVED (OFFICE USE ONLY Location �? ��/ R� ��C/ /v No. / -� Date �oRTh TOWN OF NORTH ANDOVER Com•. • O? � 9 Certificate of Occupancy $ CMU SE.� Building/Frame Permit Fee $ 13 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # -� 13650 yf� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAII`� RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:?�� DATE ISSUED: o SIGNATURE.-,-,/X—�� Building Commissioner/Inspector of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: SaL4 _a�.c� 1.2 Assessors Map and Parcel Number: G- ®o Z Z Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage(ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �6-A A-L� Name (Print) _ Address for Service: �3 �zS-v Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: EelL -Te--A- (-eo Lc. Licensed Construction Supervisor: �opv-� �v-er(� c l Ad' I ( 7s 7��t q� � 15 J Signature Telephone Not Applicable ❑ License Number -Idl�i ol' Expiry on Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 19 FAI SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify \ Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed bypermit applicant bFFICILU�SE$UNLY 1. Building(a) [q -?0 0 Building Permit Fee Multiplier 2 Electrical C6 Z) (b) Estimated Total. Cost of Construction 3 Plumbing 3-5--(D O Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 a01.00 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNEQR//AAUTHORIZEDjAAGENT DECLARATION I, ��I L 1 �\ �� ko— L y 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 F'Auc Tf-� c -ea L t Prin Si 0a ure of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 ST 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE BUILDING DEPARTIVIENI' DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properiy licensed solid waste disposal facility as defined, by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector �v►q"f� DEJ Tile Measurements (No Scrap Allowance) v p `/ 6're`t PoAd ecl Floor -- 76 sqft (includes 8 sqft rug area) Shower Floor -- 19 sqft (Not including threshold & No Seat) Shower Walls -- 121 sqft Tub Surround -- 38 6x6 (9.5 sqft) Key Design Features (Note dimensions are approximate as walls were set at 4" not 4.5"): Shower 4' x 5' (Room for Seat) Toilet 4'x 4' Tub 36" x 66" with 6" Surround on Ends and 4" on Sides (Cannot Do Jason Tub) 60° Doors to Maximize Tub Wall at 36" (8 Inch Extension) Pedestal Sink Opposite Vanity AND 8" From Door Opening 44" Vanity U ✓fw, �anzmoruuealf�i a f %�,aavricir��gel�6 ' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 054643 Birthdate: 11/19/1970 Expires: 11/19/2001 Tr. no: 9382 Restricted To: 00 ERIC D TETREAULT 390 AMESBURY LINE RD.,p HAVERHILL, MA 01830 Administrator HOME IMPROVEMENT CONTRACTOR Registration 112674 Type - DBA Expiration 04/15/01 E.T. CONSTRUCTION ERIC D. TETREAULT AMESBURY LINE RD ADMINISTRATOR HAVERHILL MA 01830 I': fir, �• ,W- The Commonwealth of Massachusetts Department of Industrial -Accidents Office of Investigations Boston Mass. 02111 Workers' Compensarion Insurance .4Fdavit h,lame Please Print Name: Location: Citi Phcr,e aI am a homeowner perrcrming all work myself. I am a sole proprietor and have no one WCrkine in any Capacity I am an employer providing workers' compensation for my employees working on this job. ComOanv name E J $-k,A-c/�u Utt Phcne r Insurance Co. Pelic/ T i Comcanv name: Address Cit/ Phcne T ( - Insurance Co. a0P-(P-U41,-a Folie Failure to secure coverage as recuirec under Section 2aA or iMGL 15_ can lead to the imposition d c:imiral penalties of a rine up to 51,500.00 and/or one years' imprisonment as •.veil as c:vii penalties in the form cf a STCP'NCRK ORCER and a rine of (S100.00).a day against me. I understand that a c p -y of ;his statement may ce fcrvarded to the Office of Investigations of the OIA fcr coverage veriflcaticn. 1 do hereby ceniy under the pains and penalties of perjury that the information provided accve is .'rue and correct. E I Cate Phone ;r S-S(0'S3 J Offic:al use only do not write in this area to to completed by c: -,y or town cr ciaf City or TcJvn PermitlUcensirc Buiidirg Dept ❑Check .f immediate response is required [I Licansing Eoard ❑ selectman's Office Contact :erscn: Fhc^e T f health Department Q Other Cl) 7) m Cl) 0 m r•M CO) .O z CD O CLrw+ W W S CZ F � 0 o p a� CT CD O a: t= O O co CD CA 10 CD CO) d O CO) c7� O CO) d C7 CD 0 CD CO)CD O z CD 0 CD O • vi O Cr v+ QO C O � CA OO! m C7 CD CCDm T ` m Z N =r -c CA O .O•►� wO H T N e ? ma�� O W CO) y O Nw ^'?m. • O O ® H ` O GIN O O O y No tu . .�0 -COO V. : Cmss: i VJ O m y CD C d m ; : rn _ y � O O 0 = co):8, cl. Ki Scr C, CO ►� occ N N O '••� :9 m H c �. ns co CD d GO 1 E; m W O � z y a4t m.. CD o�p yCD . • :� Im F CL -o= t �s= o O � d '" o Gtz o0i� p G y y to CD O G ::r r n w `� C �- '� b y n G O G a o. W CD d y O O a x tz 0 omi 0 r N° 1904 .. TOWN OF NORTH ANDOVER p PERMIT FOR WIRING %"A This certifies that .::,.... has permission to perform .....J r- ......;�......... wiring in the building, of `� �: ' 4,brth Andover, Mass. at ............... ....................... Fee, ...... Lic. No�A,—?/ ............... .......... .... ...... ................................ ELECTRICAL INSPECTOR 06/24/98 10:58 35.40 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer p - 777e Commonwealth of Massachusetts r..rrlt Ce. l Dt:partmcnt of Public Safety ev Occupant, S Fee Checked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR t 3/90 lleare blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Macsachusttu Electrical Code. S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date_ G - / 9- 9� City or Town of /yp,e� �%NOD✓E.� To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 011.94/ GreEAT /BOND C-ner or Tenant 40DN,9LD 4- 1--ogaQ/E M Ot+ner's Address SAME (978) G83 - 82$a Is this permit in conjunction with a building permit: Yes ❑ No X❑ (Check Appropriate Box) Purpose of Building Utility Authorization 140. Existing Service Amps / Volts Overhead ❑ Undgrdl t No. of Meters _ flew Service Amps / Volts Overhead ❑ Undgrd ❑ Ito. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No: of Oil Burners , Batter Emergency Lighting 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 fSelf ContaineDetection/ding devices Local ❑ Municipal nectio n❑ Other No. of Ranges No. of Air Cond, Total tons No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW NoNo. of Sief nsBallasts Wirino agFQ eLAPA No. Hydro Massage Tubs No. of Motors Total HP orrt>rR: CSS) S MO K£ _DE7TEC1r0PZ _ 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 QNO [] I have submitted valid proof of same to this office. YES ❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. ^�4 INSURANCE ❑ BOND ❑ OTHER (E] (Please Specify) Estimated Value of Electrical Work S pp Expiration Date Work to Start 4-.22 -9 ? Inspection Date Requested: Rough Final /--,2 9-98 Signed under the penalties of perjury: FIRM NAME A.D.T. SECURITY SYSTEMS NORTHEAST INC. LIC. NO. 1231C Li'cen'see DONALD A BROOKS Stgnat a NO. 1231C Address 60 William Street, Wellesley, 8 I Is. el. No.413-739-aano Alt. Tel. No. (781) 431-5831 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 .aws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Signature of Owner or Agent Telephone No. PERMIT FEE S .35 o0 Office Use Only ul�� C�nmmurtwrttltf� Uf 4Rtt,5S8r4HSrttB Permit No. f9epartment of 1jublic -S afet E Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 siso (leave blank) APPLICATION FORPERMIT TO PERFORM ELECTRICAL WORK All work to be d p n accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date - a k - City or Town of___ %� �/5�� ��i sl To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) I Owner or Tenant C) /Y )— L j/ Owner's Address 1sll (� Is this permit in conjuncts n with a builds g permit: Yes No ❑ (Check Appropriate Box) Purpose of Building eeLflip Utility Authorization No. Existing Service Amps _� Volts Overhead ❑ Undgrnd ❑ New Service Amps _/ Volts Overhead ❑ Undgrnd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Meters No. of Meters No. of Lighting Outlets y / No. of Hot Tubs Total No. of Transformers KVA No. of Lighting Fixtures Swimming Pool Above In. grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle OutletsNo. No. of Oil Burners of Emergency Lighting Battery Units No, of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total tons No. of Detection and Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No, of DishwashersNo. Space/Area Heating KW of Self Contained Detection/Sounding Devices No, of Dryers Heating Devices KW Local Municipal ❑ Connection []Other No. of Water Heaters KW No. of No. of Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: c;2�i 1,%97t6 E y� ;P"f'.4/1%* /;, n ) INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Comppl have submitted valid proof of same to the Office. YES ed Operations Coverage or its substantial equivalent. YES NO checking the apprI �°i NO C. If you have checked YES, please indicate the type of coverage by late box. INSURANCE LP' BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Elect al W rk $ _ Work to Start Signed under the Penaltie f perjury: FIRM NAME d - Licensee to, Inspection Date Requested t 9 � ^� (` (Expiration Date) Rough _-17 ~ Final ky// — k L LIC. NO. Address /IM A/ s/� Bus. Tel. No.'� Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner A (Please check one) gent v (Signature of Owner or Agent) Telephone No. PERMIT FEE $ x-6565 •j N°' 18 93 Date... ...� .... J�7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....1:!.1.... N Sv CT ` ...........(.....................:..........................tt.............. has permission to perform �` e? r^^ �' q j 0J @ 4 .............................................................................. wiring in the building of Pd .ttf ( ` ................................................................................. at ... ..1 .... G/�? f q t ..�°�!� ' ./1..�..... , North Andover, Mass. Fee.,,,II— .:U�.. I.ic. Noe 5..1.6.l............................................................. ELECTRICAL INSPECTOR CV tio7 06/16/98 08:52 40.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer l The Commonwealth of Massachusetts O ffice n , ')*M a4 "t of Pubot: $atmy point BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Ooouoen'y iso a--- � APPLICATION FOR PERMIT TO PERFORM EIEC TRICAL WORK (PLEASE PRINT IN PINK OR TYPE ALL INFORMATION City or Tawe of ! NA Oate The undanigned appNos fora permit to porform no eloeVicy work ditCnbed mater. Legation (Street & i- ,To the Inspector of VUros: Owner or Tenant � i lk� . Own 3 Address is this permit in conjunction with a CUdding permit ret ❑ AO (Ch-"Jt r•:k Purpose of BuildinriAppropriate 00.) Utility Authorizatlon No. Etisttng Service temps r Volts Overhead ❑ Undgrd ❑ Now Service • No. of AAotertL�_ mpo— Vons Number of Feeders and Location and Nara of Proposed Elerrial No. of No. at No. of No. f 40. of 40-011 of Of Wats t.te.r.■. jr4o. of OTHER: Air Overhead Q Undgrd ❑ '�.(� /J ��� fir:✓ �� No. of Transl InHrnd Generstors / No. at Emote No. of Motera_,._� TAI. FIRE ALARMS No. of Zones No. of Detection ane ---.--- NS Inilittting Oen TKW No. of Sounding Oev� No. or Solt Contained kW Oetttc:10n/Sounding Qevicea KW , ... �� it Mtrniclpal n n►rni _ —011nnmt.G t-UVERAGE: Pursuant to Me requirements of Masftnsetts — 1 hatro a Current t.iabinty Insurance Pon qac Genera! Laws Including COM01oted Op vc0d ptoot of same to this �otadons Coverage or its substantial f< YOU nava checked YES. � YES O 1V0 O equivalent. YES ❑ NO p 1 heave submitted please indirete the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Spoeiryt� Effamated value of Etaetrlcaf work s Walk to S trtspoetion pato R signed candor the -penalties of Peryury: oquestad: FtAM NAM li -'-JQ #8 Licensee ,, "a"r`_"� 4 % • 'I j) r� re�O �V y -t Addteas Y v.1 +�.� .•...— Si (E=pnatlon Aeugh Fnal tJC. NO. UC. NOS,_,__ taus. tot. N0.` OWNEA•S INSURANCE WAIVER: I ant aware that the L;eansee does not have the insurance covers Massaenuseits General lewd All. Tot. No, my 41TIQW14 all alis apalicaaon wmv go or ;ts substamial evui...r«.... ...�■ 03 lttii requitement. Ow.tw =tzl tp%.... on. Telephone No. (Siertaturo of Owner or enters C�, 73;6 Date... JO 579 Xe' �' 6 r�e' '." � . 63 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... T � J e. q ......... cc .......................... .. ... ........................ CL has permission to perform .......... Lt. A .... ............ wiring in the building of ....... ........................................... at ..... . . ..... .................... . North Andover, Mass. Fee ..... Lic. No. .............. ELECTRICAL INSPECTOR co 0 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer -.Z Location e?t �z r,4 No. Z- Date NORTH TOWN OF NORTH ANDOVER op F Certificate of Occupancy Building/Frame Permit Fee $ -- �'�s'"'°''��' s4CMUSE Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector (�6 D f98 09:21 126 117.00 PAID Div. Public Works Location No. Date r A i ' ,,•^ aY f' ssACHUSE� l� i 5 kJ °� !0E6 $ 98 09:21 TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ Building/Frame Permit Fee $ { Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 117.00 RAID Building Inspector Div. Public Works PER'ltrr..WO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. LI i PAGE 1 MAP 4-40. I LOT NO.� 2 RECORD OF OWNERSHIP !DATE BOOK 'PAGE ZONE � SUB DIV. LOT NO. I I LOCATION /Je fJ�}, j/� /� /7 /hYCQ �1` /r� PURPOSE OF BUILDING ?e/,, L� r 6)&;rLj ®I 1• �7 J �/�1�1�//!! OWNER'S NAME < NO. OF STORIES SIZE OWNER'S ADDRESS "q BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS ST 2ND 3RD BUILDER'S NAME V OSe 0�1 1p l7 / y1=C SPAN DISTANCE TO NEAREST BUILDING — DIMENSIONS OF SILLS DISTANCE FROM STREET A j POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT �l� Ai FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION /�1'L/ ��p,n1y-�es IS BUILDING ON SOLID OR FILLED LAND - WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ;/� S I 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 INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED�1/�✓ a SIGNATURE OF OWNER OR A FEE V PERMIT GRANTED 19 f IV 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST / 5�% 20 o EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED B r-- i NUILbING INSPECTOR OWNERTEL.# l� � �6d(L✓ CONTR. TEL. N a Fc5?2 CONTR. LIC. # ` ©� L— H.I.C.# /C 69 -0�a BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS __ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 1 2 13 PINE CONCRETE CONCRETE BL'K. BRICK OR STONE HARDW'D _ PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/1 1/7 �/� FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 3 _ _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ CONCRETE EARTH HARDY✓'D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I.1 POOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.I FLAT 11 SHED WATER CLOSET _ ASPHALT SHINGLES"' LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 8 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GASOI L ELECTRIC B'M'T2nd _ 10 _I2nd NO HEATING c-, 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. ON C,A LJ 6 z as w c9i a w x U w a w w a oG C,3 w a' w w as z cn o cn I R 4.J a O O O v Z O d O H C C CD rm C O.� co) O C12 m L- H CD CD Z c : O 0 CD 0 0 tC O a CL rca Q O = C C3 CD C.0 Z v c co V CO) C C • G. c. H D c� o 0 y Q C,3 ao ev CD c .4522 •� o o •- Ea O c m o CL N Ec • o m V O N � :mm • H 0 0 3 z � N co O H C C ; y IO O !O H E m .. Zi, mo aC-) b.: cm N � O :ZL O C � Q! *' o Q C ^ A\ �c �o �." o m opN Z O • C d0 cm C � O C O Q N 0 4D N W � •ill m O n 'E U= y a m�00 5 ` N =m o _ CL. =*- . I R 4.J a O O O v Z O d O H C C CD rm C O.� co) O C12 m L- H CD CD Z c : O 0 CD 0 0 tC O a CL rca Q O = C C3 CD C.0 Z v c co V CO) C C • G. c. H D MASSACHUSETTS UNIFORM APPLICATIFOR PERMIT TO DO PLUMBING (Type or print) NORTH Building Loca Owner's Name New Renovation ri Replacement FIXTURES Date p' Pe # Amount O4___ Plans Sub edr4 (Print or type) Installing Company Name iness Check one: 0 Corp. Partner. 11 Firm/Co. Certificate Name of Licensed Plumber: Insurance Coverage: Indicate the onsurance coverage by checking the appropriate box: ❑ Liability insurance policy Other type of indemnity Bond Insurance Waiver: I, the undersigned, have been mdde'aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent 11 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 ations performed under Permit sued for this application will be in compliance with all pertinent provisions of the Mass ch bi era 2 of the General Laws. By: litgnatUre 01 Licensedum er Type of Plumbing License Title /,�� go ,�,/ City/Town Lid ns mer Master Journeyman 0 APPROVED (OFFICE USE ONLY Date. lw?�.0), ' TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This cert ifies that . °f .!' ... , .V/.,"./�c,,,,,,,,,,,,, has permission to perform plumbing in the buildings of J)G k- .4 ... . at. `/5.! j>c-t7 �?U .............. , North Andover, Massa Fee ... Lic. No/,?t �.. y.., . . p/ _PLUMBING IN �ECT�R 06/19/99 09:10 40.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 11% �A Date: TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.. A�.!LAZ . ...... ........................ has permission to perform.......... ... ............................................ wiring in the building of ... 7.;/> ................. .......... at ....�/ ...... 6;.: .... /.OAP .�..... I�U ................. , North Andover, Mass. Fee ... J� ........... Lic. ........... ELECTRICALINSPECTOR Check # 7427 �4 1 Aft 01 e TuMMgt1WE3i0 "` �"`tt ttr u ill Permit Noffice Use ly i3clu rtmeM of Pub1ir ti�IIfdg Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE AL+ INT ORMATION) Date d City or Town of amu' f�, ��� 0 3/a To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Q Owner or Tenant 73(, Sq � Owner's Address bYq &ry - ba.i\ ar\ is tnis permit in conjunction with a building permit Purpose of Building Existing Service 61170 Amps /00/ of `0 Volts New Service Amps _J Volts Number of Feeders and Ampacity Yes ❑ No N (Check Appropriate Box) Utility Authorization No. Overhead 0 Undgrnd ❑ No. of Meters Overhead ❑ Undgrnd ❑ No. of Meters Location and Nature o -f Proposed Electrical Work No. of Lighting Outlets No. of Hot TubsTotal No. of Transformers KVA No. of Lighting FixturesSwimming° Pool Above In - Swimming ❑ ❑ grnd. Generators KVA r� No. of Receptacle OutletsNo. No. of Oil Burners of Emergency Lighting Battery Units No. of Switch Outlets No, of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of bishwashersNo. Space/Area Heating of Self Contained KW Detection/Sounding Devices No. of Dryers Heating Devices KWLocal Municipal Connection ❑ Other No. of Water Heaters KW No. of No. of Signs Ballasts Low Voltage Wiring 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 5a I have submitted valid proof of same to the Office. YES ❑ NO '[ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Estimated Value o_t Electrical Work $ Work to Start `S— 3 %— Signed under the P nalties of perjur} FIRM NAME -C, V l:-� s , Licensee _ h a V' _: J C' Inspection Date Requested: 75 (Expiration Date) Rough Final AAv71j,,I `32Z- LICIf,. NO. 9 ✓ v i X30 6S i �L3 Address / + �/ t,��� /y, ,us. Tel. No. Alt. Tel. No. OWNER'S INSURANCE AIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) (Signature of Owner or Agent) Telephone No. _ PERMIT FEE $ x-6565 f"' e -k: � -,I d t- 15-7 t 9 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......:` @ :. - ......... ............. -........................ G' has permission to performk :',!��. .. wiribuilding of ..r��:.�..'t'.. — at.." ...... 9�`�.... Fee X./ ......... Lic. Check # r. 1 333 { "North Andover, Mass. ELECTRICAL1INSPE R j6 r� L I 14 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 13 3 ,3 Occupancy and Fee Checked XI& [Rev. 1/071 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 7)�� �AGIi �/1 Telephone No. (q 7994yi- Owner'sAddress Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box) Purpose of Building Existing Service A, Amps / ?o/ 2-!yp Volts New Service Amps / Volts Number of Feeders and Ampacity Utility Authorization No. Overhead E�k Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location andel Nature of.Proposed Electrical Work: 4%WgWo, . 1669 dl�L-� � f� C/ 1.,, . ('mmnlvtinn n0he fnlln,e„o , , hn , ,,,a L „ /..,.„,,,,F,,....� -- -- - -� - -�-....... v�o -)W, No. of Recessed Luminaires : No. of CeilSusp. (Paddle) Fans ��/ota.��l � No. o T Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and InitiatingDevices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number Tons KW No. o Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers No. of Water KW Heaters Heating Appliances KW No. of No. of Signs Ballasts Security Systems: No. of Devices or Equivalent Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail ij desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation” coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) / certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: p C, LIC. NO.:,W-`doo yj(A Licensee: jo��_ Signatur LIC. NO.: (If appticablel e ter "exempt i to Znse na�naber line Bus. Tel. Nof %x �� i 2,6 Address: Ili /lJ or? Alt. Tel. No.:��3 N �i G,6vG *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S'- License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 111 ' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1 Address: N City/State/Zip: ` o Phone #: (q)7 � �{ -- e x, g 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 2E! I am a sole proprietor or partner- listed on the attached sheet. 1 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. ❑ 1 am 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.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.[1') ectricalepai or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other --Any appucant tnat checks box it l must also till out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub -connectors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify i�der t* ond�en r`� fperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: