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HomeMy WebLinkAboutMiscellaneous - 92 MEADOW LANE 4/30/2018Date ..... jp—A&.,/... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..:.... ...... ....... �7?................................................. has permission to perform .....,..�r..i �........... wiring in the building of.,,,,, at ........ 2:.'`....�-.%J.......� , North Andover, Mass. ............................... . Fee.;r. ......... Lic. No..t.. !��.............;5............................ ................. ELECTRICAL I46ECTo Chec4 # 11886 �w Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked ,M 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, 7-3 CMR 12.00 (PLEASE PRINT IN.INK OR TYPE ALL INFORMATION) Date: Q / City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his o cher intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address L Is this permit in conjunction with a building yermit. Yes ❑ Purpose of Building GUe y Telephone No. No Fj (Check Appropriate Box) Utility Authorization No. - Existing Service „ Jo b A ps 120 / Z 9 b 4olts Overhead R Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ir,L No. of Meters / No. of Meters Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans Total Trsformers KVA Trans 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 Detection andInitiating No. of Switches No. of Gas Burners Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers P Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices 6M - No.' of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Connection Nr, i9f Drye Y Heating Appliances KW Security,' No. of Devices or E uivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs - Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail tf desired, or as regucrea vy me lnspecror uj rr irra. Estimated Value of Elec ical Work: �QQ� (When required by municipal policy.) Work to Start: p 13 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. re / j f !7C LIC. NO.: '7 OIL— Licensee: , 1'Yir' Signatur LTC. NO.: Z 7SI (If applicable, enter "exempt" in'the license number lip?) j Bus. Tel. No. -977- 377-16 D 1 Address: '71 '` 1, ��/ Alt. Tel. No.:978 3Q2- ZIFl7 *Per M.G.L c. 147, s. 57-61, " curity work requires Departme t 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 PERMIT FEE. $ Signature Telephone No. V1 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of K, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications tions shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: ection Failed 0 r Re- Inspection Required ($.) ❑ mments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re -Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: INAL INSPE TION: Pass M Failed 0 Re- Inspection Required ($.) ❑ nspectors Comment . Inspectors Signature: Date: B WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Ngw www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Na�r�, A' � Phone #: 017T -3,o7,-2,67 Arg,you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors , �• lt/J Remodeling 2. El am a sole proprietor or partner- listed on the attached sheet. # ship and'have no employees These sub -contractors have 8. E] Demolition V working for me in any capacity. workers' comp. insurance. 9. E] Building addition [No workers' comp. insurance 5. ❑ area corporation and its 10. E] Electrical repairs or additions required.] 3. El I a homeowner doing all work officers have exercised their of right of exemption per MGL 11. E]Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13. ❑ Other comp. insurance required.] *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 aie 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. �- i a n Insurance Company Name:. SW :r7 1 Q L -or Policy ,'# or Self -ins. Lie. #: We A.1 /0 3 2 6a " MV Expiration Date: / a� Job Site Address: �Z /'Q i i) kILC City/State/Zip:/)•/f/''#/?i� Aly, 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 the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert under the pAins andAenalti' ofperjury that the information provided above is true and correct d Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # G 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 Informati®n 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 j oint 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 he. 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 Y that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial .Accidents Office of Investigations 600 Washington Street Boston, SIA 02111 Tel, # 617-727-4900 oxt 406 or 1-877rMASS.AFB Revised 5-26-05 Far, ## 617-727-7749 vvwVvauass,gov/iia I 0- 0 3 COMMONWEALTH OF MASSACHUSETTS �a I PLU.M:BER:1 AND CASFITTERS LICENSED A;; A MAS'.ER PLUMBER "ISSUES THE ABOVE LICENSE TO: it JAMES K FLA -1 FIERS 7 NICHOLAS R,l PLAISTOW N;: 03865-2222 , 10724 05/L1/14 171191` The Commonwealth ofMassachusetts Department oflndustrinlAccidents Office of Investigations •� 600 Washington Street Boston, .MA 02111 UT www.mass gov/iiia Workers' Compensation Insurance Affidavit: Builders/Contractors/Llectrieians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatiorAndividual):^ Address: /0 C j�r,i rt4� eUlf Phone #: GAP �� Are you an employer? Check the appropriate boa: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time),* have hired the sub -contractors 7 Remodeling 2, 2• k I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9• ❑ Building addition [No workers' comp. insurance 5, ❑ We are a corporation and its 10.E1 Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4), and we have no 12. Roofre airs ❑ p insurance � . re uired q employees. [No workers' 13.�Other �� �c acs �, �cce�-c comp. insurance required.] *.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 ai-e 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. Lie. #: 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 requnredunder 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 STOR WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby gertto under t* pains and penalties ofperjury that the information provided above is true and correct. o — ,E� Date: Z3� 'l.? Phone# v (�d3 (5at 62yco C��?3�,2 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. PIumbing Inspector 6. Other - - - Information and Instrueflon's. 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 inore 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 Us chapter have been presented to the contracting authority." Applicants Please fiU 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 numbers) along with their certificates) 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 maybe submitted to the Department of Industrial Accidents fox confnmation 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 -P-lease be sure that -the affidavit is -complete -and -printed legibly: The Deparkneritltas provided a space at the botfoin 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 (ff 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 maybe 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 homeowner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Tho CQmMonMal'thi ofmbssarl usetts Deparimezit ofladustdalAccidents Office of111m5 igatioans 690 WasWagtau Street Boston? 021. Z Z TO, # 617-727,4900 oyd 406 or 1:-87WASSAF Revised 5-26-05 Fay, 4 617-727-7M9 Date .... 9.) ............ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that............................................... ............................ has permission for gas installation ...... U1 ,CA� ... in the buildings of ........ * .1AJ ................................................................................ at ........... �L ..... KWAJ... VO . . . .... North Andover, Mass. Fee..f�..D . ........ Lic. No. .................................................. GASINSPECTOR Check # 88 ou 3 DRYER h = _. I I . I. _ ._ (_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK FIREPLACE CITYMA DATE s —1 PERMIT # U' FRYOLATOR I JOBSITE ADDRESS L-�OWNER'S NAME ' GOWNER ADDRESS TE _ ?, 7 -P FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: El RENOVATION: REPLACEMENT:W PLANS SUBMITTED: YESE-1 NOD APPLIANCES 7 FLOORS- BSM'1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER DRYER h = _. I I . I. _ ._ (_ FIREPLACE FRYOLATOR I FURNACE GENERATOR :J(TP .... _I GRILLE --- — - - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/ SPACE HEATER 1 _ _Rk ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER _ J INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES 1 NO m I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [' OTHER TYPE INDEMNITY 0 BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the I Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME��i4JuT _%-( Z�Lr LICENSE # /0 2_ SIGNATURE MP 9� MGF El JP D JGF © LPGI Ej CORPORATION Q# PARTNERSHIP [3# LLC [J—# COMPANY NAME: _ _.�LtkJ_ £'_ _%��` _ ADDRES,S, ;-�- CITY f _ _ _i STATE L!!!►1ZIP 03�TEL e� ��z a'"� FAX CELLFo3Gad G EMAIL cT�i � ,Z. _ _ _. �J 0 This certifies that ........... j has permission to perform . U- plumbing in pA th buildijgs of .......................... ....... . , North Andover, Mass. Fee.Lie. No ! : f ................ .. . .� . . . PLUMBING INSPECTOR Check # " q b t - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w CITY Cid I MA DATE / PERMIT #- � b! 11 JOBSITE ADDRESS �y�- Mfu,�LL�, OWNER'S NAME f>` -v Vr POWNER ADDRESS �a cw C a TEL X78 79y' Ofo ?JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL RESIDENTIA PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:PLANS SUBMITTED: YES NOD FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 S 9 10 11 12 13 14 BATHTUB t f ! _! _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM _ t m _ _! t Y_ .._f DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEMI _ ( ► I I f __.__ DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN ___.__.t FOOD DISPOSER i ._ t i Ii _J FLOOR /AREA DRAIN _ ► ___._ _.._ [ _.. (___.� i ___.___ _ _ E .._.__. f ._._ E _._..___l _.___ 1 .___ _! ___.__! INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET ! —j 1.__.__� URINAL WASHING MACHINE CONNECTION ( _-__i _ WATER HEATER ALL TYPES WATER PIPING OTHER_;0 13 e E. .___.I I - _ _ ._ ._.._.t " R INSURANCE COVERAGE: kI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES[3 5 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ' LIABILITY INSURANCE POLICY �' 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 Ell AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c pliance with a Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME s f TM&LICENSE # a 7a SIGNATURE MP;)( JPF-11 CORPORATION 0#PARTNERSHIP El #®LLC �► COMPANY NAME ADDRESS 1 -1 CITY �/ cL Scti,l —STATE ZIP TEL FAX _. CELL�3Go8(a1_a_� EMAIL e Lc cik.�, c h -- H °z z 0 F W � a � a w orl Z r o � w F 3 ce o a cn o > w � � c a O o a w~ as a J CL m coQ = w W H O O F U W a z a a x c� 16 The Commonwealth of Massachusetts Department of IndustriglAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Con>tractorslElectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): F/_ 1 Lod XC k- Address: City/State/Zip: /) / ct 13 G`vikj . A # 03&_rPhone #: Cd? 33"'l, �IC 9�2 *Any applicant that checks box#1 must also fill out the section below showingtheir workers' compensation policy information. T Homeowners who submit this affidavit indicating they 2te doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this boxmust attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Seliins. 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 the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Xdo hereby cer�ify under tltepain� qndpenaldes ofperjury that the information provided above is true and correct. 1)0(�L_1_ Date: Y - Zr ,.— Phonet V c3-3e2^`f6 y2 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 6. Other - - 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone .Are you an employer? Check the appropriate box: Type of project (required): L ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction eImployees(full and/or part-time)x have lured the sub -contractors x 7. ❑ Remodeling am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. FJ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers', 13.� Oihex t3 if/t, �e�l� comp. insurance required ] *Any applicant that checks box#1 must also fill out the section below showingtheir workers' compensation policy information. T Homeowners who submit this affidavit indicating they 2te doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this boxmust attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Seliins. 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 the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Xdo hereby cer�ify under tltepain� qndpenaldes ofperjury that the information provided above is true and correct. 1)0(�L_1_ Date: Y - Zr ,.— Phonet V c3-3e2^`f6 y2 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 6. Other - - 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone 9 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 ofhim,. 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 j oint 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 shaII 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 producedacceptable 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 chapterhave 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 maybe 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 -P-lease be sure that the affidavit is -complete -and -printed legibly. The Department llCs provided a space at the boffom* 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and shpuld you have any questions, please do not hesitate to give us.a- call. The Department's address, telephone and fax number: The Commozlwealth of M-assachmotts Dep.artment of. Znduddal Accidents Ofte of Inlvestigatiou 600 Wasbington Street Boston?M. A,021Z1 TO, # 617-7274900 oyt 406 or 1:-87WARSA.FF Revised 5-26-05 Fax # 617-727-7749 Date ..�..'-..�..�.'�...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... �� ...........R CT/zC. ....................... has permission to perform ......A..............r..%....:.............................................. wiring in the building of......�!.... ..............:............................................... at �-�..,,.,,., ,North Andover, Mass. ..................................................... ................... CU Fee, .:.', - .... Lic. No. L.1.98 ........... >_ .. .......... .......:.............................. t ELECTRICAL INSPECTOR Check # �'�l 121917 00, Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Only. Permit No. Occupancy and Fee Checked tev. 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 r0 y: 4 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: A.10kT ( Aly -0d UCS- To the Inspector of Wires: By this application the undersigned gives notice of hi or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant POP r AL/ 1 hrT Telephone No(7-Q�la3 Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building _5(1Y6-1- E /_AM 1 L Y j40/Lf ZE Utility Authorization No. Exist ingService Amps / Volts Overhead ❑ Undgrcl❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: �S e �j/� / jy G /� if -M 017 L&__ k17- AA N i T/ Dr. r VT� rmmnletion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Sus (Paddle) Fans P ( No. of ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires ONE rnd. rnd. Swimming Pool Above ❑ n- E:1 o ighting Battoter Units No: of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners M. o eteng D an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices Disposers No. of Waste Dis P eat u Totals um er ons o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal E] Other Connection No. of D ers rY Heating Appliances KW Security ystems: No. of Devices or Equivalent No. of Water KW Heaters o. of No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications 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 ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO. Al 1 983 Licensee: LOUTS ('_ONTTNO Signature . LIC. NOa�2R788 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.:9 7_8=3.6 3 _ ; 4 2 0 Address: 1— NnvnN nu WEST NPW ruv NA 01 a88 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, securitywork 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: $ 1�4 N 4f�, . 4"1, -/,f pkn c Date ... .t.�.� .................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that 6` 2' co has permission for gas installf tion t......�u....P in the buildings of... .... t�C-fi......................................................................... at ..... "?....'G..?:w.......L!`!.:................... North Andover,, Mass. Fee..'-�O....... Lic. No..�5.....��...''"�'.. ......... ...................................................... GASINSPECTOR Check # q�P61� 9326 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 10 /11 It I CITY I North Andover I MA DATE 5122120144 PERMIT # I v JOBSITE ADDRESS 92 Meadow Ln OWNER'S NAME GOWNER ADDRESS Same TE�- 1FAxE TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ® RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 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 OTHER _ Replace 1 Gas Meter x INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES a NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c liance with all Pertinent provision o e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Marino LICENSE # 8736 SI N URE MP Ej MGF ® JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑# 3285C PARTNE HIP❑# LLC ®# COMPANY NAME: RH White Construction Co ADDRESS 41 Central St CITY I Auburn STATE MA ZIP 01501 TEL (508) 832 3295 FAX 508-926-4347 j CELL 508-832-4614�EMAIL JMarino@RHWhite.com 1 36 '� w F O z z 0 F U W a, d z w f °O z z o U❑ w } O O w z F au LU z W a a a o W Q w U a z a a a � U x J F a a. iii x w I --LL. W F O � O U W w z C O a v iw 0 ca rtk WI it MNI -05 1w. ul UJ LL co r_j U?Lu w <Z .0 1-4 I U. l,q 1-4 LL ..w .0 0 1% 0 OM > U), = Zd -0 U).a: C3 LM UJI LU Lu< .1VIX IA, oll :Z.J.z ow. 4t A ............ IS ACORD ® [TATE (MMIDDryyyy)�--CERTIFICATE OF LIABILITY INSURANCEPage 1 oP 1 1 9/2013 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE, ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policOes)must be endorsed. If SU13ROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polioies may require an endorsement. A statement on this certificate does not conferrights to the Certificate holder In lieu of such endorsement(s), willia Of Massachusetts, Inc. C/o 26 Contury Blvd, P. 0. Box 305191 Nftmhville, TN 37230-5191 R. E. White Construction Company, Inc. 41 Cmntra3, Street P. 0. Box 257 Auburn, MA 01501 VMNQ_EM a11'��Z 676 1'rbi'd.o); 8813..4 -2378 VF AILADDRF,� cextificate�c�w•illis,com INSUR ER(8)AFFORDING COVERAGE NAIL rr INSURERA:The Chartor Oak riro Insuranco Company 25615-001 INSURERS: Tre<vo],grs Property Casualty C*A�Ipany of Am 25674-003 INSURERC:Neti=A l Union Piro lnsuremaa Company o£ 7.9445-001 INSURERD; Trovelere InB�ztyr Company 25658-DO1 -W"M��v t,CrcrlPIUA11 NUM13LR: 2 02 87 6 8 0 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INpICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPEQFINSURANCE MAWvv aun pOLICYNUMBER POLICYEFF POLICY EXP A nn GENERALLIA6ILITY VTC2000 97799948-13 9/7./.2013 •9/2/2014 EACrI I1( COMMFRCIALGENERAL LIABILITY ���I CLAWS -MADE OCCUR nnan c GENLAGGREGATF LIMITAPPLIES PER; B C D D AUTOMOBILE X LIABILITY aNYAUTO ALI,OWNED SCHEDULED AUTOS AUT08 HIREDAUTOS X NON -OWNED AUTOS Co Dad X Coll Dad UMBRELLALIA1, OCCUR PXCE58LIAB CLAIMS -MADE N(A VTJCAP 977K955A-13 838766140 '+Tk2gUEi 8205A185-13 VTC2XUB 8203A73A-13 9/1/2013 9/1/2013 9/1/2073 9/1/2013 9/1/207.4 9/1/2014 9/1/207.4 9/1/2014 OMBINEDSINGLF,LIMIT aaccldent S 21000,000 BODILY INJURY(Perperson) 6 BODILY INJURY(Peraccld(W) 6 X araccldent X 5 6ACHOCCURRENCE $ g-000 000 X AGGREGATE L 000, 000 Or V RETENTION$ :L0 0001 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNFRIFXECUTIVE NN OFFICERIMEMIK11 EXCLUDE. MendetoftyylnNN) des In I dnr u��unrrnuvuFCP�RAnorlsnelow --A, S X 0 TAI?,Y LI E.L.EACHACCIDENT F 1,000,000 E.L.DI8SA9E-EAEMPI,pYarz $ 1,000,000 EJ.,DIBEASE•POLICYLIMIT 1,000000 FE EVya'9nce of rom=ance more epeco SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED A9PReseNTATNE Coll:4197604 Tp1;1694012 Cert:20267680 ©9988-2010ACORD CORPORATION. All rights reserved, ,CORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD F11% COLLOPY ENGINEERING CONSULTANTS 65 Ayer Street METHUEN, MASSACHUSETTS 01844 TEL/FAX (978) 685-8069 JOB L� N ) DDI 71 d N H. .......:.. -0 .. ....... . / SHEET NO. CALCULATED BY OF DATE // Ff G CHECKED BY DATE Lo 1 SCALE H. .......:.. -0 .. ....... . Location cya ne�Smu.) L. /j -c- No. `i Date 11 -1q -0a Of NORT1y TOWN OF NORTH ANDOVER AL •. O Certificate of Occupancy $ 00 Building/Frame Permit Fee $ / ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # f S 16024/� / 1�4' wilding Inspector A7 2J, 0.2— TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Aye>N',�s.: .'"„'ss"�r�'�RS'�h�'s.t� ... _.. ., ..... BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Ifuildings Date SECTION 1- SITE INFORMATION 1.1 Property Address:: 1.2 Assessors Map and Parcel Number: / 9Z1&�e4do I.J L,/�Yvl � 6,.. �/S:_ O I , _ / A+ Map Number Parcel Nurfiber 1.3 Zoning Information: 1.4 Property Dimensions: 2 /,/Y7 /d Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide . Required Provided R red Provided D 13j, 7-2- 30 o 1.7 Water ly M.G.L.C.40: 54) 1.5. Flood Zone Information: Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal On Site Disposal System ❑ Public Private ❑ , SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record !92- M 2�ej � L} Lm,e__ AJ a •, (% Name (Print) Address for Service: A76) a Signature elephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: Number ALicense Address / A 315 -2, 00 `� '976 ro (3 7- 7 0 to Expiration tate Sifnature Telephone 3.2 Registered/Home Improvement Contractor Not Applicable ❑ 4 Company Name Registration Number //04jv. CIO tj4,,-- Add s � - 76 (o "_a G g % Expiration Date Si ature Telephone 9 I� SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 6 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 builft permit. Signed affidavit Attached Yes .....A No ....... ❑ SECTION 5 Description of Pro osed Work check all appficable New Construction ❑ ,Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ♦ !. r /aa �R. l Accessory Bldg. ❑ Demolition ❑ Other ❑, Specify . Brief Description of Proposed Work: o�vs-e SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be OFFICIALVSE ONLY Completed b ernut applicant r p.' 1. Building (a) Building Permit Fee b 0 D Multiplier 2 Electrical (b) Estimated Total Cost of 2_, o D o Construction 3 Plumbing CV Building Permit fee (a) X (b) 4 Mechanical(HVAC)D© 5 Fire Protection 6 Total 1+2+3+4+5 Q 0 Do 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 OWNER/AUTHORIZED AGENT DECLARATION 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 e �I J. Print e f� z� n� • Si cure of gicient Da� SOME NO. OF STORIES SIZE J ' BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST ? 2ND 3RD SPAN l DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS�-- HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING W X O MATERIAL OF CHFIANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Ve S IO- 93 -61R, FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT_ ►���/ i �Sv,a PHONE � 4P�7-�b(� LOCATION: Assessor's Map Number PARCEL -q0 SUBDIVISION LOT (S) STREET }til oiow� ST. NUMBER�� ************************************OFFICIAL USE ONLY*********************************** ENDATIONS OF RVATION ADMINISTRATbR COMMENTS TOWN PLANNER COMMENTS DATE APPROVED , DATE REJECTED DATE APPROVED DATE REJECTED_ FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm } ' ' ✓ir.0 L/ Q?!7/l9ZOJidlAW1. a,'..4KWadwJW 4 ,. BOARD OF BUILDING REGULATIONS i t License: CONSTRUCTION SUPERVISOR ' Number: CS 001724 f, Birthdate: 03/05/1956 i Expires: 03/05/2004 Tr. no: 20722 i Restricted: 00 KEVIN J SMITH _ 1"(Q HIGH STREET+ ? N ANDOVER, MA 01845 Administrator I I .. ✓1ze �a�,v�,wn..uea�lir. o�'✓�iaavac/:�.eeka Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 108511 Expiration: 8/19/2004 Type: Individual SMITH CONSTRUCTION CO. Kevin Smith 110 High Sty N Andover, MA 01845 Administrator t .. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Name Please Print Location: �7, Z r-tCLQ t e,. City 0 A dyV-V- Phone # 7.5 4 S 7 0 6Z I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity zI am an employer providing workers' compensation for my employees working on this job. - I / - - . c- iA Company name: Address City Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment_as_well_as_chdl.penattiesinsheformd-a STOP..W. _ORK ORDFR.and..afine af_($1Il0.D0)-aday.against.me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certifypgder the Print of perjury that the information provided above is true and correct. Official use only do not write in this area to be completed by city or town official' City or Town Permit/Ucensina Building Dept rICheck if immediate response is required Q Licensing Board El Selectman's Office Contact person: Phone #: E] Health Department r-, Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of� 1)e41 V1L-e. Ivs 129 s /. _ocation of Facility) )" I /-- — A S' ure 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 CERTIF-1f,o PLOT' PLAN tJ o Fx--r %-A OI lP� k V 9 •7� L S -r o Ia Y I G+OC� e3 39 tr+ M.34' ON THE BASIS OF MY "OgEME AND INFORMATION I FIND, TIHAT AS A RESULT OF A SURVEY MADE. ON THE GROUND TO TIHE NORMAL STANDARD OF CARE OF PROFESSIONAL LAND SURVEYORS PRACTICT`x' IN MASSACHUSETTS TME LOCATION OF THE FCJNDATICN IS AS SHOWN :HEREON . DA ° JA c ABELY J• C P S. NO. 28520 �v 9�FESS��o 1✓,4, t• - A >✓. Fps. Pa F PREPA9-ED 8Y: tJpl�Tt-iE2N ASSOG. I t�lG. <v30 7U9NPItLE STREET' N. A1NPOVE9?-, mA. 05C67) ")7G-7117 O F=04 w d �> p u°. v Q7 cn w z A ° w° U cd w w a w°' id w a O U w a°' cn ro w" O aw. z d pp ap' w w Q w CO z cn v �C cn E m 3 Q ,cm o S. c C3 o COD yCc, il O m Z .5 0 t: coo a Q � y m C O V� O C m uj _V V ea = m C O C O O v LLJ oc E Qno z CLMw d Ea Qo 3 D m.- = ` H 0 FE m =,a5ma y a � N E — c CC� ,o = m C o. c E C.: 3 •. F m h a C C � A-! H O ++ E m 3 Q ,cm o S. c C3 o COD yCc, il O m Z z 0 w w a 0 ,i7 CO O Q 0 Z O 0 y H .CO L coCL C O CO Q M ro7 CO) O O V CO2 O v Lij 0 U) LLJ CO W W IrLU Lij U) t: coo a Q � y m C O V� m uj W ea = m C O LLJ oc E Qno z CLMw O. O: Qo m.- = ` H 0 FE m =,a5ma z 0 w w a 0 ,i7 CO O Q 0 Z O 0 y H .CO L coCL C O CO Q M ro7 CO) O O V CO2 O v Lij 0 U) LLJ CO W W IrLU Lij U) w.l z �N O g � I gGI � r0 �3 z_ r„ o I a I I I � I O a �x O KD I � I I-- I N 41 —J z o Opo � oo ztA opo � o 0 14' 3 Z4�6N" O g � I gGI � r0 �3 z_ o� rn�o 3 Z4�6N" O az � I gGI � �3 z_ o a rot a �x KD �\o I-- r 3 Z4�6N" 1- 246 'ANS�I'S�1�" r� r O az � gGI � o a rot a KD I-- � N 41 O t� 1- 246 'ANS�I'S�1�" r� r az � gGI � o a rot N r C �t Iz Iz zi o r a a Gl 1 it I N r C �t �4 I -N2 2315 Date ....../v��.s TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that I has permission to perform ... b a,: f:.k.a . d.0. ..:......:............................. wiring in the building of......''?./a....................................................... at .... .`�../'k'1.e a.c.�� .....L-!�.................... . North Ando fr, f Lic. Not ✓va.......... .................. / ...�.......�... } ELECTRICAL I SPECTOR Check # I WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 7BEGOM IONWE4L7HOFMASS4CIWJSETIS Office Unly 1111 DEPARTMEVTOFPUBIKS4MY Permit No. 'Op��SS/l ri BOARDOFFREPREVEMONRWUT4TT01N527CMR12.0 Occupancy &Fees Checked UVAPPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 L S D (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dati. Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. - 7-2y Location (Street & Number) 9 me.C,_a Li ) L (1 Owner or Tenant D�eO- (3c-0 c-v,.fi. - Owner's Address Is this permit in conjunction with a building permit: Yes 0 No a (Check Appropriate Box) Purpose of Building �jiv.�1Zwu ��k �tNzt� �� Utility Authorization No.� Existing Service Amps / Volts Overhead Underground Q No. of Meters New Service Amps�Volts Overhead Underground 1:3 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �c.t�•cc�ow� Co v�h �:� S No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundg1:1round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal a 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 Insua=Cmage, Laws ItmeaamutLiabtItyhstrar=Pobymdj&gC Caaagecrits ecgnvaiat YES a NO M IhadesthnftdvMptoofof=netotheO>f= YES n NO r Ifjauhmedt dWYFS,plemeudc*thet)WcfwmaWbydmkirgthe RqSURANCE a BOND OTIIFR VkmeSpecif') WotktDStart IttspediatDr�eRetted SigheduxkrSRm kxsofpajtay FIRMNAME EslimWedVakrdUM0idWodc $ RD* Final LioffwNa IjCH19eC \:c. �� CG Li=lsENo 3`1 0 2 �I BuskmTdNa was 1Lir Sgc�H,tCJC- h 'k-0(4 O2/4/� Ak.TdNh X551— �Y4 -7(01 �xwu O"WSRsBURAIVCEC WAIVER;I.anmmthatthei.iceusedmnat Lam anddvin ys�at mand ispardWpiiattwai,.zftmquaanatt. (Please check one) Owner a Agent n �--■+ Telephone No. PERMIT FEE • v Date. 1-/71<- N° 439'8 TOWN OF NORTH ANDOVER �a �c PERMIT FOR PLUMBING a i r • o � r SSAcmus�� This certifies that ................ has permission to perform ............. plumbing in the buildings of ....�� . .............. at .. r W c, l c: < ...............North Andover, Mass. Fee. Lic. No.. 9 ....... �� . ,., ..,:r--tr7......... ;.PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer U MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS ,� -- �-- l �/� � Date Building Location P.4 /i L�/ Owners Name �. /,�� Permit / Amount Tvoe of Occupancy / New Renovation Replacement 1:1 Plans FIXTURES Yes r No 11 (Print or type) , Check one: Certificate Installing Company Name n Corp. Address '[Am G �l' D D Partner. % Firm/Co. Business Telephone Name ofLicensed Plumber. �- Insurance Coverage: Indicate a type insurance coverage by checking appropriate bolt Liability insurance policy Other type of indemnityEl Bond 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 cgnamm Owner Agent E] 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 in,'s�t,�l�detions {under Permit Issued for this application will be in compliance with all pertinent provisions of the hyTT "7T; S e.//e� 14Z of the General Laws. .own ROVED (OFFICE USE ONLY Type fPlumbin' g cense icense i um er f Master Journeyman . ®/. N2 1572 Date .................................. NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING KWEIVED PAYlVill T A", 13 0 5 F This certifies that . ................................. NORTHANDOVEF .......................... �A-S, has permission to perform .-. ............... LEGTOR��- . ........ .. 7, r ................ .... .. wiring in the building of ... . ................................................................ at .... ....... ,North Andover, Mass. NOW— ..... Fee..................... Lic. No . ............. ............................................................... ELECTRICAL INSPECTOR 04/05/99 1; WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office use only The Commonwealth of Massachusetts /�- 7p_rano NO. Department of Public Safety Occupancy & fee Checked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 (leave blank) CATION 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 RRdTYPE ALL INFORMATION) Date I Z CA ('A 6\ City or Town Of 4v, -c- To the Inspector of Wires: The.undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 12. Owner or Tenant Owner's Address.-� . Is this permit in conjunction with a building permit: Yes ❑ No L_1 (Check Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps 1 Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and d Location and Nature of Proposed Electrical Work C -O 1 0 Q va_ 1(_ S U chi x ON \A- `3 -\-r34\ of Lighting Outlets %No. No. of Hot Tubs No. of Transformers TKoVtAl No. of Lighting Fixtures Swimmin Pool Above In- g grnd. 11grnd. ❑ Generators INA Nrof Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units _ Nr. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total 3 No. of Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local Municipal Other Connection No. of Disposals Po No. of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers y Heating Devices KW B No. of Water Heaters KW No, of No. Of St ns Ballasts Low Voltage Wirin No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabilit Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES C] NO 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. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Estimated Value o Electrical Work $ l7 ^� Work to Start 2L Inspection Date Requested: Signed under the ienalties of perjury: Rough Expiration Date Final FIRM NAME--- LIC. NO. Licensee Signature ,.c�_f�_l_ �d LIC. NO. 1_7% qD Address 1tis� Bus. Tel. No. � � +� S ' �� ��' ' Alt. Tel. No, CAI 1 332_"' g0 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requiremen_. Owner Agent (Please check one) GOJJP.�,� Telephone No. 1 `f 9 �i 0 V 0 3 PERMIT FEE S Signature of Owner or Agent D O m D Z z � m m v COMMONWEALTH OF MASSACHUSETTS), DIVISION. i OF ELECTRICIANS ' EGISTERED MASTER ELECTRICIAN ISSUES THIS LICENSE TO in ASSURED FIRE ALARM COMPANY IN6'2 RONALD G DEMAIO 70 AUSTIN STREET ,cn NEWTONVILLE MA 02460-1844 16170 A 07/31/01 739546 a COMMONWEALTH OF MASSACHUSETTS DIVISION OF REGISTRATION, OF ELECTRICIANS ., AS A REG JOURNEYMAN ELECTRICIAN, a)y ISSUES THIS LICENSE TO Y RONALD G DEMAIO CE 70 AUSTIN ST 1; NEWTONVILLE MA 02460-1844,, 27390 E 07/31/01 739547 z �,-ftfiOfmassacf►uxits :: DRIVER9S,,LiCIENSE<- —27-99 v 023462753 066�1JvP.WTICE -. - DR 9. L EMA10" RONALDIr. 926 BREENDALE AVE �- �'* NEEDHAM MA 92 ' COMMONWEALTH OF MASSACHUSETTS), DIVISION. i OF ELECTRICIANS ' EGISTERED MASTER ELECTRICIAN ISSUES THIS LICENSE TO in ASSURED FIRE ALARM COMPANY IN6'2 RONALD G DEMAIO 70 AUSTIN STREET ,cn NEWTONVILLE MA 02460-1844 16170 A 07/31/01 739546 a COMMONWEALTH OF MASSACHUSETTS DIVISION OF REGISTRATION, OF ELECTRICIANS ., AS A REG JOURNEYMAN ELECTRICIAN, a)y ISSUES THIS LICENSE TO Y RONALD G DEMAIO CE 70 AUSTIN ST 1; NEWTONVILLE MA 02460-1844,, 27390 E 07/31/01 739547 n I Li s QO n , n 3 D 0 CDD C N �D M 0 C w Q m N 71 a� N° 1 5 7 2 Date.........................!....... C e`er �0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....?'........................................... has permission to perform.......... .......................... ^ . ..... ... wiringin the building of ................ ....................................................... •����` '....... , North Andover, Mass. ........ .. . i Fee4... ......... Lic. No............................................................................. ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Location f {... No. G ^� Date, TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ `^ Foundation Permit Fee $ r Other Permit Fee Sewer Connection Fee Water Connection Fee TOTAL i zt !` 1090 05/20197 15:33 Building Inspector 25, oo PAID Div. Public Worl:s 1 :i ` f Lr3�7 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. I% PAGE MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK ;PAGE ZONE SUB DIV. LOT Nth. I — I I LOCATION eQ Q 'a PURPOSE OF BUILDING t�ZA&LLf N Q, ' OWNER'S NAME / 1/1 �% u L�_ NO. OF STORIES ZE OWNER'S ADDRESS 1�2i BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBE IST 2ND 3RD BUILDER'S NAME e (^ SPAN 7� DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET DIMENSION SILL 0--�/'GCYYI 14 l it � !►o a DISTANCE FROM LOT LINES - SIDES REAR l roCl4 AREA OF LOT FRONTAGE IS BUILDING NEW -UN�AITI O THICKNESS SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION reS / a-� em . e IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Ye -s 7i IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 18 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 SIGNATURE Of?"60OR OR HORIZED AGENT FEE PERMIT GRANTED,�/ Iq/1 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM C" SEPTIC PERMIT NO. 4 APPROVED BY MUILDING INSP[CTOR OWNER TEL I ! y `D J CONTR.TEL/ CONTR. LIC. # H.I.C.# 1030r7 7 BUILDING RECORD 1 OCCUPANCY 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. ''• lTt SINGLE FAMILYI STORIES MULTI. FAMILY OFFICES APARTMENTS I _ CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. _ PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 EASEMENT 11 AREA FULL FIN. 8 M TAREA A 1/% FIN. AINC AREA _ NO E M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WAILS I 9 FLOORS CLAPBOARDS CONCRETE EARTH HARDl�'D COMMON ASPH. TILE 8 1 _ 2 �_ 1_ 3 _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY SILICCO ON FRAME 1 Y BRICK ON FRAME ATTIC STRS. & FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR IJ POOR ADEQUATE I NONE 10 PLUMBING 5 ROOF GABLE GAMBREL I I HIP MANSARD BATH 13BATH 13 FIXE 701LET701LET RM. FIX.) ) _ FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE TAR & GRAVEL NO PLUMBING STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 8 FRAMING i l 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 e •• • � �_� 1 GOAL ci cri oir III 13rd 1 11 NO HEATING I I U a X i Mcod, r O f— a �u''�J` o .G N Q a w 'c'.. ! r i b. -.y m ! 44 O N Cc -F.— ! i O V - i { ' O tT .q ' o O H � • va •.ti C �I u2 w O E3 y .. r,... ip Awa..•.i.w.....Mwr..w...ws...,,,r;, via np ��1 NZ 7 _H phi cc C, �l -•�� n.r H k � PO lv] 's, P4 a z (7 E n'. � M 1 � , a ter•. to �. - .f O H .aJ H u ti V - p: (4vf, A ++ ; a X i r O f— a o SL N Q a w 'c'.. ! v °` S i b. -.y m ! - W ...r m Z 0, CL Cc -F.— ! i i { .. rb co L E N �O O i N C co omc CD C 7 m O C �C L O Z 0 O WA I rz 0 3 o O� C H O C O CJU0 O. C A t O o n: Ea E mCE m •L is r d E_ w chi w aG U x w a tkD lz w a aG u w" pG u: 0 W cn cn L E N �O O i N C co omc CD C 7 m O C �C L O Z 0 O WA I rz 0 3 o O� C H O C O CJU0 O. C A t O o n: Ea E mCE m •L is r d E_ 000 V 0 co SL C A N 0 0 N 3 co m C m OM N : 19 EH m � nc�) y m m C C yQ o w ,0 v' Z C O CL Q N m C mL 3 a y W c tyvt� m �+r O C.L.. O G tC3 d22 N ci 0a 0 C42 a N =4D O 'v �= O = L O i CL m L E N �O O i N C co omc CD C 7 m O C �C L O Z 0 O WA I rz 0 LocationT No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ S MUSE ~l j�2 x't _ ref , T/ -Otho Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ SEP._ j Building'inspector Div. Public Works m LIVA PERMIT TO BUILD - NORTH ANDOVER, MASS. VIPAGE 1 MAP -NO. LOT NO. 12 RECORD OF OWNERSHIP IDATE BOOK '.PAGE ZO E- I SUB DIV. LOT NO. OCATION PURPOSE ._ro v ] OWNER'S NAM 'j i NO. OF STORIES SIZE G7 OWNER'S ADDRE G1f 1?� _L �j 5p / `►O BASEMENT OR SLAB ARCHITECT'S NAME - SIZE OF FLOOR TIMBERS IST 2ND 3RD �y UILDER'S NAME {�Y 1 / _ 1 V SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS ILDING ALTERATION Y -P c - r-c,,j 4- re IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQYUIIR-EMMENTS OF COCDE �j [ 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 A�N}D- APPROVED BY BUILDING INSPECTOR DATE FILED Qw/Yf Q J SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTE 19 OWNER TEL. #�-✓ CONTR. TEL. 3 PROPERTY INFORMATION LA '`COST EST. BLDG. COST EST. BLDG. COST PEREST. BLDG. COST PER SQ. FT. V EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN ` BUILDING INSPECTOR bY��......., O.- 1 OCCUPANCY 12 _ LIj14d SINGLE FAMILY I SiOR1ES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION g INTERIOR FINISH a 1 2 13 PINE CONCRETE CONCRETE BL'K. BRICK OR STONE P _ PIERS PLASTER DRY WALL — — — _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA Ih '/v '/, FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ ALLS 4 WALLS----779_ I g FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES CONCRETE EARTH B 1 2 3 _ _ ASPHALT SIDING ASBESTOS SIDING VERT. SIDING HARD!✓'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 SUPERIORI� POOR _ ADEQUATE NONE 10 PLUMBING 5 ROOF GABLE GAMBQEL I HIP MANSARD BATH )3 FIX.) TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING 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 GAS OIL B'M'T 2nd _ laf 13rd ELECTRIC NO HEATING 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. M T., W x w p CION W o2 u z z d or .Z U cz � z z � co a RH u z z U H °n °c W p u w d °°n C w w w a w G =v m z° C/) ;; Q -E° cn c� 0 •as c c � O � O t C L N 0 IIvv ev ev as c �t o m Tc t5 .. c2 as ` r•+ N O 0 o� : CJ Ca c aZZ CO) m co L N cc J C m A 't C ' N A co 1 O CD C2 =V L N 67 O o :acs m o � m Z C=3 o c o c C9CD =CD '+ m dt O C •+ C3 � V Qf C3 O H •— O L t a E a CA N O i N C O R cm 03 cm m o` cm c •c 0 N G� O Z 0 CDa J a J Q z LL cc W a_ cr z z C) w cc cc Q W WCl) z O 0 CION W � CQ LL ui � N_ •E °c W O" C y - N z cc H t c� 0 •as c c � O � O t C L N 0 IIvv ev ev as c �t o m Tc t5 .. c2 as ` r•+ N O 0 o� : CJ Ca c aZZ CO) m co L N cc J C m A 't C ' N A co 1 O CD C2 =V L N 67 O o :acs m o � m Z C=3 o c o c C9CD =CD '+ m dt O C •+ C3 � V Qf C3 O H •— O L t a E a CA N O i N C O R cm 03 cm m o` cm c •c 0 N G� O Z 0 CDa J a J Q z LL cc W a_ cr z z C) w cc cc Q W WCl) z O 0 Location/ % /&dc`Qc," /N No. C0 Date y y 40RTN TOWN OF NORTH ANDOVER O:t«o :•'�y0 •. • O Certificate of Occupancy $ Building/Frame Permit Fee $ X36' �ACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3887 l/4 "1 '6-"�---- ? Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEaMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: e, SIGNATURE: Buildin missionerfl for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel NurAber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage il 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 70 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone lnformatioa: Zone Outside Flood 1.8 Sewerage Disposal System: Public Private 0 Zone S Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record. SA Name (Print) Address or Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number dress i ID Expiration Date Signature Telephone 3.2 Regist Home Improvement Contractor Home Improvement Not Applicable ❑ l p Company Name Registration Number Ad ess se—�— Expiration Date Si nature T&Whone SECTION 4 - WORKERS COMPENSATION (M G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: L SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beOFFiCIAL Completed by permit applicant U 1ISE ONLY 1. Building �---� (a) Building Permit Fee Multiplier 2 Electrical f —� (b) Estimated Total Cost of Construction a p ©, _ 3 Plumbin-----, Building Permit fee (a) x (n) / 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) iJ Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNEERRS OR CONTRACTOR APPLIES FOR BUH.DING PERMIT AGENT as Owner/Authorized Agent of subject property Hereby authorize ` to act on rr,beh ii 'a Matter relative to work authorized\byttQbuilding permit applicati n. f �� '3 Si nature ofOA-m-Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, vJ 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 m Nam Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB `—' - '-3�w - SIZE OF FLOOR TIMBERS V;1 2N') 3 RD SPAN DIMENSIONS OF SILLS '2 DINIENSIONS OF POSTS �.Le.,s D11VIENSIONS OF GIRDERS v HEIGHT OF FOUNDATION 4, THICKNESS '5 SIZE OF FOOTING \ ` X MATERIAL OF CHRANEY ' iv IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �/ FORM U - LOT RELEASE FORM �i INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from - Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. AFFLICAI�T FILLS OUT THIS APPLICANTt9j�"2T LOCATION: Assessor's Map Number SUBDIVISION STREET OFr1CIAL USE ONLY' PHONE FAFCEL � LOT (S) ST. NUMEER l R 4Ze VWNDAT12.NS OF TOWN AGENTS: g 16 aN� �'�� 0494 e2 Q( CO t-RVATION ADMINISTRATOR DATE APPROVED DATE REJECTED r COMMENTS (W ()a ob.<1-Xn Ce TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE.APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY BUILGING iNSPECTOR Revized 9\97 im DATE CM10'.1 L-.-p-r - 21 40"P O� L I I s 7, W em c, .r�Z 111 -1 ON TIS BASIS OF MY MCWL UGE AND INFORMATION I FIND, THAT AS A RESULT OF A SVRVf'Y MADE ON THE GF"= TO THE NORMAL STANDARD OF CARE OF PROFESSIONAL LAND SURVEYORS PRACTICING IN MASSACHUSETTS THE LOCATION OF TFC FWNDATION IS AS SHOWN MRflON . sa-v.13" f X Lc»- - Is L,,4r-1 >✓ Ad'T8: �ltls�c 115#94 PREPARED W 0 w --r H C sZ N &360 TURNPIKE STiLEET N. ANDpVF-Q-, MA. 15087 S74-711-7 A/DI11:11® PRODUCER .............. INSURED M.P. ROBERTS INS AGCY INC 1060 OSGOOD ST NO ANDOVER MA 01845 KEVIN MURPHY DBA MURPHY REMODELING 169 BOXFORD STREET NORTH ANDOVER MA 01845 JISSUE DATE (MM/DD/YY) 3/27/00 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE .............. ......... ... COMPANY A LETTER COMPANY B LETTER .......................... COMPANY C LETTER COMPANY D LETTER :.......................... COMPANY E LETTER COMPANIES AFFORDING COVERAGE .................................................................................................. MERCHANTS INSURANCE CO ................................................................................... MERCHANTS INSURANCE CO ................................................................................... GUARD INS GROUP IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ITHIS INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ............ ............................ ..................... ................................................................................................................................................... ............... ....................... ................................... T TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION:LIMITS LTR: DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY CCP -8593726 11/22/99 .11/22/00GENERAL.AGGREGATE . $2 0001OOO ... ................................... X COMMERCIAL GENERAL LIABILITY q PRODUCTS-COMP/OP AGG. -.s2 0 0 0 , 000 ................ ........................ ........................................ ­­ "" OCCUR.: PERSONAL & ADV; INJURY CLAIMS MADE: I........ $1 .� 0 0 0 f 000 ..... ......... :::::::::........:.................................... :OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $11,1000 000 .. .................................................................. FIRE DAMAGE (Any one fire) ............ I........... $10 00 0 O .. ................................. ... : ........................................................... MED. EXPENSE (Any one person) . $ 5,.' 0 0 0 AUTOMOBILE LIABILITY _ AM02 7 7 013 6 0 8 1/23/00 1/23/01 : COMBINED SINGLE $500 LIMIT ANY AUTO ....._..............................................._.........._..........._........ OOO ALL OWNED AUTOS BODILY INJURY r $ X SCHEDULED AUTOS (Per person) .................. ............. HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS ........................... _.......: GARAGE LIABILITY ...... PROPERTY DAMAGE $ I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS x av t� : aG w 6 cn a Cf) o w GO a z Q .a b o w bo o 04 v E U m c x w a V a o r_G is c w a ow � U a Wm to o c� to J) c w x u w �„ � o a4 m c w z d A w v C w z �, cn Q v C/)— n ' m c ��� ;E c � c� c E c N •co u CL c A : m C E< ICD CCM ca 0 LA O .O �E m co ow Z O� 3� co CJ 0� cc O a Q.. CMQ yccC O= C CJ -J -0 co ca C Z CD 0 CL C.3 CO) � C C C C. H D 0 U) W T- Lli LLJ Ir LijW (/) Xcow m N E� :cw :oo c CD CL= E L Nm m m m a y�m3 t Q cm N c O _ 'C.3N N c O �: c O • = m CL m �: —q: 2 Co :.� s o 0 os c CLct m CED 0 O Hcc c Z 0 O L O o. CR _c = y m ® C m p c N CD o -COO Z �. c .. •N A CD F. oc at E w C •N Z o V m p O Cie CO) O' m' O� .00 h •O A S awm ICD CCM ca 0 LA O .O �E m co ow Z O� 3� co CJ 0� cc O a Q.. CMQ yccC O= C CJ -J -0 co ca C Z CD 0 CL C.3 CO) � C C C C. H D 0 U) W T- Lli LLJ Ir LijW (/) Date. R7 NORTH o TOWN OF NORTH ANDOVER O O? Ap IN PERMIT FOR PLUMBING F ,SSACNU9E� This certifies that ........ 1� , has permission to perform . ... '0 2 c� ��...... plu ing.inatthe buildings of ...f�. P /.... . at ." ``'Y--.-- �,...,., North Andover, Mass. G Fee. s . Lic. No4',O.` l ;� . ............................... tPLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ice: (Print or Type) NORTH ANDOVER, , Mass. Date 9-- , . jg Building eq Permit Location . _ Owner's /4 Name.✓ New ❑ Renovation Replacement ❑ Plant Submitted: Yes ❑ No. ®/ •9l- Check one: Certificate Company Name A/A ❑ Corp. Address ❑ Partnership A/ Y'1116 qf(rm/co. Business Teiep one �J t S S Name of Ucensed Plumber CRIA JA INSURANCE COVERAGE: ec I have a current liability Insurance policy or No substantlat equtvaient. Yes No ❑ If you have checked y . please Indicate the type coverage by checking the appropriate box A Ilabllly Insurance policy ID" • Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licenses does not have the Insurance coverage required by Chapter 142 of the Maas. General Laws, and that my signature an this permit application waives this requirement. Check one: Signature of Owner at Owner's Aaant Owner ❑ Agent ❑ I hereby mOty that al of the detaJls and Inlormallon I have submttted (or entered) in above appileatM as true and &=urate to the best of my krwwiedge and that al plumbing work and instaladons performed under the permit Issued for this ap by cornplarxa with all pertinent provisions of the Massachusetts Slate Phrmbing Code and Chapter 112 of the Ganwal lawe�l/ Af'P XMD (OFFICE USE ONLY) Ir Ucense NL nbw MIA Type of Plumbing Manse: Masser Q / Journeyman Q' Date ....„...%.. i-"- 898 f NORTH , TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 11 x • oma'"'+'"'EPEE"`` --�-' `,+' # ;,SS�ICHUSE� This certifies that ......... C a.rn...... .�.�.J. �' �C (- ............................... 4 has permission to perform ...... Y.!c1?.?............................................... wiring in the building of ..... e o...{a....... �1'�< ct 4 fi ....................... ( v at ........1.....i .r�(cdot.N..... ........................... . North Andover, Mass. Fee ........ Lic. No/7 1) ........................ .......:.......................:....... ELECTRICAL INSPECTOR G(V 1 05/01/97 13:49 25.00 RAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer LIM The Gvmrnonwealth\o` IWO Massa f chusettsDcparrm"t of public Safty rer.it .w. BOARD OF FIRE PREVENT70N REGULATIONS S27 CMR oc�"r�ncy1?00 3/.90 APPLICATION FOR PERMIT TO PERFORM ELECTRAll work to be performed In accordance *✓th heMaacachustu EJtetrical Code. 527 CMR (PLEASE PRINT IN INK OR TYPE ALL INFO ION) Date City or Town of ... y4 To the Inspector of Wi The undersigned applies for a permit to. perform the alectrl�al -to . rest �.,.._i._. Location (Stvtet & Number) Owner or Tenznt Owner's Address Is this permit in conjunction with a building permit: Purpose of Buil Existing Service Acips Z / Volts tics+ Service Amps / Volts Number of Feeders and Ampacity` Location and Nature of Proposed Electrical Work _ P -i _1l zU s' ct� No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle outlets No. of Switch Outlets No. of Ranges No.. of Disposals No. of Dishwashers No, of Dryers No. of Water Heaters 1W No. Hydro Massage Tubs No. of Hot Tubs Swimming Pool Ab r NO. of Oil Burners t:o. of Cas Burners FIRE ALARMS - - No. of Zones No, of Air Cond. Total Cons No. of Heats Total To - Tons Si s Ballasts No. of Motors Total H? IcUtility Authorization N0.es L0 No LJ (Check Appropriate Box) dv"o, � Overhead ElUndgrd ❑ N foo.. !deters Overhead ❑ Undgrd ❑ No, of Meters 4 c*�t ''1.1%k ' Cl* Sa, No. of Transfomers Tot e In- KY' • ❑ d, ❑ Generators . Rvl No. Of %tneroonm, r No. of Detection and Initiating Devices tel --------._. lea No. of Sounding Devices p� No. of Sel Contained Detection�Sounding Devices KOX W Local ❑ Municipal Othe Connection❑ Low .Voltage:.; - ..._. Wirin apace/Area Heating Heating Devices No o. OTHEk: APR 2 9 1997 rl 13 INStI?.P.NCB COVERAGEt Pursuant to the requirements Of Ma,ssachusatts General Laws I have a current L bilit Insurance Policy including Completed Operations Coverage or;s substantial equivalent. YE NOj� I have submitted valid proof of same to this office. YES NO If you hav�YtONDEI eked YES, please indicate the type of coverage by checking Che propriate box, IN SURAN,B OTHER (J' (Please Specify) ��0 i Estiaated Value of Electrical Work(�ic�ion ate War; to Start Inspection Date Requested: Rough /met Final Signed o..�er the pe allies of perjur;: ®� FIRM NAM>; S' C U-.,ST� - .. LIC. N0, Licensee Signature ._.. AddresLIC. N0. oi1'N&R'S INStJRAhL'>: wAIYERf Y am aware that the Licenses does not have tie.insurence coverage or to au - stanrial equivalent as required by 1'Latnahuaatta Cenerel ws, an that my signature on this permit application waives this requirement. Owner Agent (Please check �;ne) SigTelephone No. PERMIT FEE S nature of ie; or Abent —" . v The Commonwealth of Massachusetts Office V$e Department of Public Safety Ptrelt NO. BOARD OF FIRE PREVENTION REGULATIONS 527 CMP 12=0"` "Mr 6 rte c h e c k e d - 3/90 ( leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL Wp All work to be performed In accordance wflh the Maus chustcu Eltclrical Code, 527 CMR 12:00 (XILEASE PRINT nq INK OR ME ALL INFO ION) '! Data z C' City or Tows pectoi o ir'est _ To the Inspector of Wirest The undersigned applies for a permit to perform the elec11 trical work described below. Location (Street & Number) Owner or Tenant Rn Owner's Address U Is this permit in conjunction with a building permit.. yea 210 (Check Appropriate Box) Purpose of Building % � Utility Authorization NO. Existing Service ��.._,_..._Amps / Voits Overhead EJ Undgrd No. of Meters trrwr Service - k'ps._ / Volts Overbead ❑ Uad d Bt No, of Heters_,— Nomber of Feeders and Ampacity Location and 214ture of Proposed Electrical Work ct, ��• "L kiting Outlets Na. of Hot Tubs No. of Lighting Fixtures Swinning Pool AboveIn- grnd. ❑ )srnd. l �Z Receptacle Outlet i;v. of v> j Burners 0. 0, Switch Outlets 1;0. of Gas Burners No. of Transformers Iota Generators Ir No. of Emergency Lighting Battery Untts FIn ALARMS No. of Zones '40. af Ranges No. of Air Cond. Total No. of Detection and N_ Disposals tone No. of Hp�t Total Total Initiating Devices �--� „. Puz�s ron4 Ed No. o: Sounding Devices No, Dicjtiwasz.ers )aco/Area Heating No. of Set Contained Detection/Sounding Devices No. of Dryers Heating Duvices KW Lacal Municipal Other Connection❑ _ r tri ,e r Heater.. } - _ Na, o o. o Si. ns Ballasts har_A101 at`ge_--_-- .. �^ 1assage Tubs No. of F4ators Total lr i APR 2 9 1997 �- COVERAGE, Pursuant :c �.,. teq.:.r_oencs of Massachusetts C.enenl!LaWs -- — 1 L.. a currentbilit Insurur�ae Policy including Completed Operations Coverage or i;s`sueqL. 'a14nt. YEPNO I terve submitted valid prof of canoe to this office. YES h4 [� f Y=y hive checked YES, please ir.�.cait tho type of coverage by checking the propriate box. J $7.'!D ❑ ()T2�:i( _.�.� tPlease SpeciFy) _ -�`��_ ..:.ted Yalu:; lsctrical work WpUa—tion ate toStwrt_`Inspection Date Requested: Rough Final r~ed ti �er th'Ie� r,c,tal tits of per jur. ; RM NAME � (-Tv� LIC. N0. �� J Signature�%�-�4B5.3 _ a? LIC. No. �LYC Q �'0�� G.1� a _ Tel . o o. S�8 '7 G.7MR'S INSURANCE 'WAIVBRI I am aware that the Licensee does not have c1t TNsurence coverage or is eu - cquivatent as required by Yascachunocto General ws, an th-. signature on this permit 7i1`� �n waives this requirement. -:mer Agent (Please c' .w s) ral:..rone No. PERMIT FEES (Signature of Yer os Agent 3663 i Date ..... ee�l1. ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that — fl c T ' . ��. ........t,- .............�?.. ........... y`dlkJ w 2r... has permission to perform ...................................................................... wiring in the building of.Q/��� ....... _................................................................... ,7, w at......................�. P`.....�............................orth v ass. Fee - Ud .. Lic. No. _ y $LECTRICALINSPECTOR Check # Commonwealg a/)Vamachudelfd Official Usc Only 7 �7 ePart`nrenE ol.}ire �ervices Permit No. BOARD OF FIRE PREVENTION REGULATIONS [Occupancy and Fee Checked Rev. 11/99) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to he performed in accordance with the Massachusetts Mcciricai Code (;NIEC), 527 ChIR 12.00 (PLEASE PRINT IN INK OR TYP`L• ':ILL rVF01?,11,-1710N) Date: City or "Town of: fy� To the Inspector of 1,Vit•es: By this application [he undersigned gives notice of his or her intention toerform the electrical work described below. Location (Street & Number)_ /'Z' ) L' Owner or Tenant Owner's Address Is this permit in conjurtction ivith a buildinb permit? yes ❑ Purpose of Building S(h( ti Existing Service Amps / 1'01ts New Service Antl;s / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. No LV (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Conr letion of the 1ollowina table nta L - No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans t c ..u..cu vv role jny cctor• of mires. tVO• of Total Transformers KVA IV o. of Lighting Outlets No. of hint Tubs GeneratorsKVA / No. of Lighting Fixtures Stivimmin Pool Above ❑ In- ❑ Swimming 1 0. o Emergency ig itmg orad. rnd. Battery Units FIRE ALARMS No. of zotres No. of Receptacle Outlets No. of Oil Burners 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 a No. of Waste Disposers Heat Pump I Nuniber Tons _ KW No. of Self -Contained ntai �- _ --�� Totals: Detectior>/Ale Devices No. of Dishwashers Space/Area Heating KW Local ❑ itiIunicipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems: t`io. of Water No. of No. of No. of Devices or Equivalent Henters Kiv Situ Ballasts Data ,✓irino- No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total IIP Telecommunications Wiring: OTHER: f No. of Devices or E uivalent (� PiyV 'Ylit� ` ew t'ue A«aadditio/rat detail ifdesired, oras regrtired by the Iltspector of ;Vires. INSURANCE COVEILAGE: 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 zo;,ege is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURl\NCE OND ❑ OTHER ❑ (Specify: C� /.�%u .0% v az' Estimated Value of Electrical Work: (When required by municipal policy.) {Expiraton a Work to Start: Inspections to be requested in accordance vrith MEC Rule 10, and upon completion. I certifj, « ndcr t/fe pains anr! pc/ralties of perjury, thailliehifor» tatiot� this application is true and corn lute FI101 NAME: Licensee: Signature (If applicable, elder "'e nr t " it the licence rut r line)) W Address: -OWNER'S INSURANCE WAIV & Z: I ani aii,6re'that the Liceiuee does required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature 'Telephone No. LIC. NO.: LIC. NO.: Bus. Tel. No.: la Z3 -kg - Alt. Tel. No.: not have the liability insurance coverage normally I an, the (check one) ❑ owner ❑ owner's at -,en FPj;-RJ1'1T 1Y E: S <5� U.j - / Date.... HOR7M °`,"'° ;•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ......... J.... . �.................. n. C....... U .............. has permission to perform .....!!�//...�.f�/..//....... � l.�.0........................ wiring in the building of (a�...�(�!'! ........................................................... gcCd w U........ North Andover, M }at ................... ...................................... Fee ... �. U:. O... Lic. No.%� J. J. 3............ ,. ........... ... ......� .......... �C 4 916 A / ELECTRICALINSP R Check # Official Use O'fnlyy Permit No. L De/rantxerx �u8lle Saaety Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS,527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 C R 12:00 (Please Print in ink or type all information) Date /p &.70 Z� To the Inspect of Win: Town of North Andover The undersigned applies for a permit to perform the Location (Street & Owner or Tenant Owner's Address_ Is this permit in conjunction with a building permit Purpose of Building 5/,0 �A Exigting 0 Nur%ber of Feeders and Ampacity Location and Nature of Proposed Electrical described bel` Yes ❑ No LLY (Check Appropriate Box) //2#0 volts voits Overhead Authorization No. CJ 6 5-53 Undgmd ❑ No. of Meters Undgmd ❑ No. of Meters OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = mitted valid proof of same to the Office YES = NO = If you ha ed ed YES please ipdl ,e tfl�type of co rale bychecking the appropriate box INS NCE = BOND = OTHER =. (Please Specify) (/ / (Expiration D e) b7 Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Signed underthe Penalties of perjury: .J� {� ) FIRM NAME /_& C - d/ i7 A inal LIC. NO. - - r v - ��j Bus. Tel No. Address " 6 1 AA Tel. No. OWNER'S INSURANCE WAIVER: I am awa that the Licenses does no have:the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my,signature on this permit application waives this mq►iirement Owner Agent (Please Check one) Telephone No. PERMITTEE $ t�y.-6)0 (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices No. of Sounding Devices No./ of Self Contained No. of Di osal Heat Total Total No. Pumps Tions KW Noz of Dishwashers S ace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No of Water Heaters KW No. of No. of Bailases Low Voltage Wiring No.. Hydro Massage_Tuds rNMotors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = mitted valid proof of same to the Office YES = NO = If you ha ed ed YES please ipdl ,e tfl�type of co rale bychecking the appropriate box INS NCE = BOND = OTHER =. (Please Specify) (/ / (Expiration D e) b7 Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Signed underthe Penalties of perjury: .J� {� ) FIRM NAME /_& C - d/ i7 A inal LIC. NO. - - r v - ��j Bus. Tel No. Address " 6 1 AA Tel. No. OWNER'S INSURANCE WAIVER: I am awa that the Licenses does no have:the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my,signature on this permit application waives this mq►iirement Owner Agent (Please Check one) Telephone No. PERMITTEE $ t�y.-6)0 (Signature of Owner or Agent) 3871 / Date ....... Q � TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ..... .. �a.cC........ ............................................................ has permission to perform ........ . .......................................... I wiring in the building of ............. �5`?................................................. at ...........1...,,��.// ..........1 ..� ..... 5 ............YELRICAL An/do�v r, Fee. JSE w... Lic. No../. S..0 .............`.................. . .... PECTOR Check # C Official Use Only Permit No.. ?�fGn edn�l2G�rI��.L1%�f I� yl2>�.S,SrgL'�ZLS�7'7.S V041r-`Ott 4;Vd?- s44 Occupancy & Fee Checked___ . BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 C j�Ri1 :00 (Please Print in ink or type all information) Date t /,3 To the Insp ct r of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Purpose of Existing Number of Feeders and Ampacity. t Locatiod and Nature of Proposed Electrical Work Yes ❑ No V (Check Appropriate Box) Voits VO .Utility Authorization No. Dau 0Overhead Undgmd ❑ No. of Meters Overhead L� Undgmd ❑ No. of Meters OTHER: . w l aC A i) o — "r l /Yi'iC N n S INSURANCE COVERAGE. Purlkuant to the requiremen6ts of Maachusetts General Laws I have a current Liability Insurance Policy including Completed O erations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If youcheck Y S please indicate the type of co ra e b checking the appropriate box INSURANCE = BOND = OTHER = .(Please Specify) bl" [CIO V ,J (/A 1 121 (ExpirWo D;t(e) l Estimated Value of Electrical Work$ Work to Start Inspectiolr Date Signed under the Pie FIRM NAME U Q / }� 1 r'}.ancaa SJ V . p �% �\ it LIC. NO. 1— e` ! r Bus. Tel No. 1 ,50 l c.� 0— Address J O tC (7,et /C'Y! J Alt Tel. No. OWNER'S INSURANdE WAIVER: I am aware that the Liceiceensse does not Have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) LL r No. PERMIT'FEE $ ✓?✓ 'va (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets / No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.1of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No.'Sf Dishwashers Space/Area Heabng KW Detection/Sounding Devices ❑ Municipal ❑ Other No:bf Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors TotaIJHP OTHER: . w l aC A i) o — "r l /Yi'iC N n S INSURANCE COVERAGE. Purlkuant to the requiremen6ts of Maachusetts General Laws I have a current Liability Insurance Policy including Completed O erations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If youcheck Y S please indicate the type of co ra e b checking the appropriate box INSURANCE = BOND = OTHER = .(Please Specify) bl" [CIO V ,J (/A 1 121 (ExpirWo D;t(e) l Estimated Value of Electrical Work$ Work to Start Inspectiolr Date Signed under the Pie FIRM NAME U Q / }� 1 r'}.ancaa SJ V . p �% �\ it LIC. NO. 1— e` ! r Bus. Tel No. 1 ,50 l c.� 0— Address J O tC (7,et /C'Y! J Alt Tel. No. OWNER'S INSURANdE WAIVER: I am aware that the Liceiceensse does not Have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) LL r No. PERMIT'FEE $ ✓?✓ 'va (Signature of Owner or Agent) Date.. A % O; 3- TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... / . /,0, ... 6 .. , - - C .......... .. .. ........ ..... . . ...... has PeAission to perform ............ /Y ............ �Ael ................................. wiring in -the building of ....... at .......... .................... ............ North Andover ass. ....... .......... Lic. ......... .,..r- ... ...... ..................... ��&�RICAL INSPECTOR Check # /,/) / 4333 - � ul�r C�ummnnwp�i#1� of ��ss�r,4�usr##s Department of Fire Services o BOARD OF FIRE PREVENTION REGULATIONS Q,N Official Use Only / < ,S Permit No. 7` 3✓ Occupancy and Fee Checked 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 /N INK OR TYPE ALL INFORMATION) Date: :Z —14 0 3 City or Town of: XIO (iZT I—( A lytg,✓Fr�_ To the Inspector of Wires: By this application of the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 12, At CXW— lQc -LA � Owner or Tenant ' 63 ri-T' C— 14-L L,,+,/,G7-- Owner's Address SAA -\,.C. Telephone Is this permit in conjunction with a building permit? El Yes Q No (Check Appropriate Box) Purpose of Building Existing Service _ Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Overhead ❑ Utility Authorization No. Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: 6A /L1, I L_„ Conpletion of the following table may be waived by the Inspector of Wires. c yG� No. of ecessed Fixtures No. of Ceil.-Susp. (Paddle) Fans &N E No. of Total Transformers KVA No. o Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above In. grnd. grnd. No. 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 Initiating Devices No. of Ranges r g No. of Air Cond. Total G� Tons No. of Alerting Devices No. o., Vaste Disposers Heat Pump Totals: Number Tons W No. of Self -Contained Detection/Alerting Devices No. of ishwashers Space/Area Heating KW Local Municipal [_1 Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. of 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. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee pro- vides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov- erage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE CX BOND ❑ OTHER ❑ (Specify:) A Estimated Value of Electrical Work: (When required by municipal policy.) xpiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: CONTINO ELECTRIC &'CABT.P. TNr LIC. NO.: Ah83 Licensee: LOUIS CONT INO Signature LIC. NO.: E 2 8 7 8 8 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-363-5420 Address: 1 nnNO VAN nRT` p., WFST N -F BURY, MA ni 985 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By m signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ FORM F.P. 11 HOBBS & WARREN - BOSTON (REV. 11/991