HomeMy WebLinkAboutMiscellaneous - 93 PLEASANT STREET 4/30/2018rl)
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Date ........... 11/3-1 / .............
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that..
.......................................................................................
has permission for gas installation --- (Y,4 ...........................................
in the buildings of ............ ..... ..
... .................................................................
at ............... �. J ........ ...... ................... . North Andover, Mass.
.....................
Fee:&.� ... Lic. No4,�!Q2 . ..... ... /'-/6 . . ............................................... .
GASINSPECTOR
Check# //j L/ 7)
9092
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY MA DATE Wilt
JOBSITE ADDRESS OWNER'S NAME
GOWNER
ADDRESS C TE ?-7 kAX
TYPE OR
PRIINT
OCCUPANCYTYPE COMMERCIAL El EDUCATIONAL RESIDENTIALM
CLEARILY
NEW: El RENOVATION: REPLACEMENT: El PLANS SUBMITTED: YES NOEP
APPLIANCES -1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12
13 14
BOILER E::j E::j L:j L::j L::J !:::D_ r [:::j
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE F—I
GENERATOR
GRILLE
N)
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
,jTEST __j
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
.. ........ . . . .............. ........ . ... .. .. . ...... .. . .....
__j --I ------
INSURANCE COVERAGE
I have a current liability insurance or its substantial equivalent which meets the requirements of MOL. Ch. 142 YESWNO
policy
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 41 OTHER TYPE INDEMNITY Ej 13OND
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 F—] AGENT Of
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 Fno--wledge
Will ithj
and that all plumbing work and installations performed under the permit issued for this applicafion be in com )1i p ision of the
MPee
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUM BER-GASFITTER NAME lenn LICENSE #2� SIGNATURE
MP VV MGF EjI JP E] JGF [] LPGI D CORPORATION PARTNERSHIP 0#= LLG?#
COMPANY NAMEIA�m�. Mw_&t� 4- fl] ADDRESS )5;4 ek-1
CITY Ij/ STATE � ZIP �?_]TEL
FAX JCEL&Wt 61*/ EMAIL
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u) El
LLI
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LLI
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U) LU
LU
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The Commonwealth of Massachusetts
Department of lndustrialAccW�fs
Office of Investigations
600 Washington Street
Boston, MA 02111
Uf . www.mass.gov1d1a
Workers' Compensation Insurance Affidavit: Builders/Contrac,tors/Electricians/Plumbers
Applicant Information Please Print Le2ibly
Narne, (Business/Organi-zation/Individual): o2
Address: I
City/State/Zip: 1,2CO?yZ "d Phone#: 476_:!? �i?L`_,
Are you an employer? Check the appropriate box:
1. El I am a employer with
4. [11 am a general contractor and I
employees (fall and/or part-time).*
have hired the sub -contractors
2*1 am a sole proprietor or partner-
listed on the attached sheet. t
- ship and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. 1 am a homeowner doing all work
right of exemption per MGL
myself [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.) t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. New con struction
7. Remodeling
8. F1 Demolition
9. n Building addition
10. F1 Electrical repairs or additions
11. E] Plumbing repairs or additions
12.0 Roofrepairs
13F1 other
TAny 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 ft're doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
lam an employer that isproviding workers' compensation insuranceformy employees. Below is thepolicy andjob site
information.
Insurance Company
' Policy # or Self -ins. Lie.
Expiration Date:
Job Site Address: City/state/Ziv:
Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
Faffure to secure coverage as required under Section 25A of MGL c. 152 can lead to the" osition of criminal penalties of a
IMP
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi th
J Z!7 =dlt* qfperjury that the in,formation provided above is tr eandcorrect
n
OV
Phone#: 6e�7 66 S
Official use only. Do not write in this area, to he completed by c4 or town official.
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone ff:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "....every person in the service of another under any contract ofhire,.
express or implied, oral or written."
An employer1,s defm'ed as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint 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 licensmg 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 ?or the performance ofpublic work -until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ 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 coverag'e. !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
Industr , ial 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 Eno. I
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 th6 Office of Investigations has to contact you regarding the applicant.
Pleas ' a 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 Addrese" the applicant should write "all locations in ity or
_(c
town)." A copy of the affidavit that has been officia4y stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is'on file for firture permits or licenses. A new affidavit must be fillqd out each
year. Where a home owner'or citizen is obtaining a license or -permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank youln 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 numben:
The Commonwealth. of Massachwetts
Mpartment of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel # 617-727-4900 oxt 406 or 1-877rMASSAFE
Revised 5-26-05 Fax 617-727-7749
__WWW_Mass.goV1dia
.1
9
i
)NWEALTH OF MASSA
I . , I (r)) I(A
Dat........... —13 .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... ......... I ..... %�I.U.e .....................
has pennission, to perform
wiring in the building of ......... ..................... I ...................
at ........... ...... 0 eAaLt-� Andover, Mass.
...... ....... !,North
Lic. No. ........ 0. fk
FA...) ... ...... ... . .. .. .............
C INS- OR
Check#
U
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�C\ Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
(Please add zip codes & electrician's cefl #
contract # & bid permit # if anplicable.)
Officio Use Only
Permit No.
Occupancy and Fee Checked
,ev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORAL4 TION) Date: /0 - C-7 - go/:3
City or Town of-. Abrtl? lkdollel- To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant Telephone No. 5��- -?;w
-De,6
Owner's Address sr, -ri -e-
Is this permit in conjunction with a building permit? Yes El No [4�� (Check Appropriate Box)
Purpose of Building 965 Utility Authorization No.
Existing Sery - ice c900 Amps /o'ZO /,V,(' -',;)Volts Overhead E;--' Undgrd No. of Meters
New Service Amps Volts OverheadF� Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
a -/A/ !�� Po ;7,9A If 0% R� R - A J 7-. a I A A% -La
Completion nfthp fnllnwina tnhlp mni) Ao —Aiad Ai) tba � W;
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
N o. 5 Jit- iaf
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
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,
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
J.Nqyftr
I
-'r-KW
of Self -Contained
Detection/Alerting Devices
No. of Dishwashers,
Space/Area Heating KW
Local F-1 MunicipPl El 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. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start:/0 -/0 ���13 lnspections�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 cove ge,is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: fNSURAN1 PIOND 0 OTHER F1 (Specify:)
I certify, under the.pains andpenalties of perjury, that the infoo . on this application is true and complete.
FIRM NAME: ir e y -Ugc- LIC. NO.:
Licensee: Signatuic LIC. NO.:
6 -e-J
(If applicable, enter t in the, licensq number line.) Bus. Tel. No.:
Address: V>J) Op �),C IL4,W;1.0 M, 14- \-Afn) Alt. Tel. No.,VV--VA-
*Security �`ygtc7m Contractir 1:icenst&qu -w6rk; if arpfica-bli, enter the license number here: 'y �
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) [I owner F1 owner's agent.
Owner/Agent
Signature Telephone No. FPEJ?MITFEE.- $
N
3995
ir
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
has permission to performl.,.-"4,-,."-e..,,.�,.,-o?.�c . ... . ........
wiring in the building of ......... ....... .....................................................
at ..... ......... . North Andover, Mass.
Feel� ... . .... Lic. No. 1'76,2--.? ....... I... 142K - ��c
ELEcrRICAL INSPEcrOR
Check #
Official Use Only
9
Permit No. 13
VO4%ra� 4PA&, Sapff Occupancy & Fee Checko_S�-�3-J
BOARD OF FIRE PREVENTION REGUI_ATIONS.527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
AjI work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date —
To the Insp4ctor QN Wires:
Townof North Andnvp-r
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & NumbeF::���31 9 -C "7 -F
Owner or Tena 0
Owner's Address_____a_6_2Q2
Is this permit in conjunction with a building permit Yes No 0 (Check Appropriate Box)
Purpose of Building 1 01 Utility Authorization No.
E)dsting Service_�), Amps____----YOits Overheadr Undgmd 0 No. of Meters 0-1
New-SeWce Overhead 0 Undgmd 0 No. of Meters
Number of Feeders and Ampaci
Location and Nature of Proposed Electrical Work 0, (, -e 12:) L n ( i
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a curr&nt Liability insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER = (Please Specify) (P_Xpiratlon Date)
Estimated Value of Electrical Work
Work to Start, Inspection Date ResqueslFW__ I —Rough —Final
signed underthe Penalties Do ry
- P.1 " A L
FIRM NAME g , j/127 C IC. NO.
0
"2 -/JC- Bus. Tel N'oj 5� !J 9 11 IR 2
Addressz?a�, rhl4jalkl sr- n-v91rJ f!5:) Alt Tel. No
�not havethe insurance c&erage or Its substantial equivalent as required by Massachusetts
OWNER'sTNSURANCE WAIV R: I am aware that the Licenses does
General Laws. And that my,,�Ignature on this permit application waives this requirement Owner Agent JPlease Check one)
yelephone No PERMIT -f EE $'7;;Q(5
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. 4 Transformers KVA
Above 0 In 0
No. of Lighting Fbdures,
Swimming Pool
gmd 11 gmd 0
Generators KVA
I
No. of Receptacles Outlets
No. of Oil Burners
No. of Emergency Lighting
Battery Units
No. of Swi Outlets
No of Gas Burners
FIREALARMS No.ofZone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diposal
No.
Pumps Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
0 Municipal 0 Other
No. of Dryers
Heating Devices
KW
Local Connection
INIM Of
No. of
Law Voltage
No. of Water Heaters KW
Signs
Bailases
Wiring
No. Hydro, Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a curr&nt Liability insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER = (Please Specify) (P_Xpiratlon Date)
Estimated Value of Electrical Work
Work to Start, Inspection Date ResqueslFW__ I —Rough —Final
signed underthe Penalties Do ry
- P.1 " A L
FIRM NAME g , j/127 C IC. NO.
0
"2 -/JC- Bus. Tel N'oj 5� !J 9 11 IR 2
Addressz?a�, rhl4jalkl sr- n-v91rJ f!5:) Alt Tel. No
�not havethe insurance c&erage or Its substantial equivalent as required by Massachusetts
OWNER'sTNSURANCE WAIV R: I am aware that the Licenses does
General Laws. And that my,,�Ignature on this permit application waives this requirement Owner Agent JPlease Check one)
yelephone No PERMIT -f EE $'7;;Q(5
(Signature of Owner or Agent)
0 L)a t
e.
7'OWIV OrVoRrif AIVOO
1.. 4%
4cofus
Thi, certifl-es that
has p,,, . . . ., /I ) I
S'on to PC
Plurnbi,g.i
at. n th e b Uildings Of
Fee. c-,
10
Check N
rth Andov
er,
Pt
n tvspEclron
MASSACHUSETTS UNIFORM APPLICA
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location 73- 5�5- 0/ 1
/f 4-t wners Name
O -A - S.FO — 1001
Type of Occupancy
New La Renovation 0
Replacement 0
FIXTURES
Pla I ns Submitted Yes El No 0
(Print or type) -T,/ --�- C C) Check one: Certificate
Installing Company Name 4-H . aCorp.
Address V%- C "J -C.(t e f., 0 Partner.
Busines7felephone 4-C .0 Firiii/C
0.
Name of Licensed Plumber- TV J,
Insurance Coverage: 1ndicate the type of insurance coverage by checking the ate box:
Liability insurance policy . 0- Other tyl:�e of indemnity 0 Bond E]
Insurance Waiver. 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
ignature I Owner 0 Agent 171
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work- and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the MassachuseLp3 StateTlumbing-Gode and Ch f-1/1") 'P.1,
By:
Title
City/Town
APPROVED (OFFICE USE ONLY
-F U e General Laws.
TYP�X Plumbing License
. u- -7 -7
License RUM= — Master Journeyman F1
Date. �� -.e' - 0 t
.. ...............
,ORT#q
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation Ili-. q .............
in the buildings of ..... Q.Q.0.1 ..............................
at ... C/. 3. -. . �. � —. . . . C. / - /-. f - —. r—. . .. . , North Andover, Mass.
Fee. Lic. No ........... ....... � . ......
GASINSPECTOR
Check# Q ?
NLASSACHUSETIS UNWORM APPLICATON FOR
GAS HUNG
(Type or print) Date
NORTH ANDOVER, MASSACHUSEWS
Building Locations ?3- '5 Permit #
Amount $
—Owner's Name PJ d -
New Renovation Replacement Plans Submitted
I
(Print or type) one:. Certificate Installing Company
Name, I V Corp.
Address Z) PU(--( A-- r. c 5 Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [—] Noo
If you have checked M please indicate the type coverage by checking the appropriate box.
Liability insurance policy [� Odv-T type of indemnity 1:1 Bond
Owner's Insurance Waiver I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement
Check one:
Signature of Owner or Owner's Agent Owner r_1 Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State C)ps C9de and _5*ter 142 of the General Laws.
(OFFICE USE ONLY)
Signatu�"f Licensed Plumber Or Gas Fitter
Plumber W'G __? -7 1 -
0 Gas Fitter License NumSFr
19 -M -aster
0 Journeyman
3RD.FLOOR
SWIM �11
(Print or type) one:. Certificate Installing Company
Name, I V Corp.
Address Z) PU(--( A-- r. c 5 Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [—] Noo
If you have checked M please indicate the type coverage by checking the appropriate box.
Liability insurance policy [� Odv-T type of indemnity 1:1 Bond
Owner's Insurance Waiver I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement
Check one:
Signature of Owner or Owner's Agent Owner r_1 Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State C)ps C9de and _5*ter 142 of the General Laws.
(OFFICE USE ONLY)
Signatu�"f Licensed Plumber Or Gas Fitter
Plumber W'G __? -7 1 -
0 Gas Fitter License NumSFr
19 -M -aster
0 Journeyman
".jr- , �'i
TOWN OF NORTH ANDOVER
Office of the.Building Department
Community Development and Set -vices
27 Chiirles Street
North An dover, Massachusetts 01845
D. Robert Nicelta,
Building Commissioner
January 4, 2002
Atty. Lynda L. Saracusa
346 North Main Street
Andover, MA 0 18 10
Dear Ms. Saracusa:
Telephone (978) 688-9545
FAX (978) 688-9542
Please be aware that I am in receipt of your letter dated December 17, 2001 in regards to the
condo conversion of the property located at 93 — 95 Pleasant Street in North Andover.
There are no inspections or requirements that I am aware of that are needed or required for this
property to be changed into condos.
Properties are only inspected if building, electrical or plumbing permits are obtained and the
responsible contractor caUs the appropriate inspector.
I hope that this answers your questions. I may be reached between the hours of 8:3 0 — 10: 00 AM
and 1: 00 — 2: 00 PM at 978-688-9454
Respectfully,
Michael McGuire
Local Building Inspector
Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Diozzi, GaslPlumbing Inspector
PhaningDepannient 688-9535 Conm-%Y�ilion Dcpartment 688-9530 Heilth Dcpatiment 688-9540 Zoning Bond of.Appeals 688-9541
ATTY. LYNDA L. SARACUSA
346 Nowrii MAiN STREET TEL-: 978-470-2148
ANDOVER, MA 0 18 10 FAx: 978-470- 2119
http:lhvww.saracusa.com
Email: Ivnda aracusa.com
December 17, 2001
Mr. Robert Neceta
Building Inspection Department
North Andover Town Olfices
Re: 93-95 Pleasant Street, North Andover, MA
Request for Letter of Opinion for Condominium Conversion
Dear Mr. Neceta:
I represent the owners of the above property. They would like to convert
their two family home into a duplex condominium.
Would you please advise what if any inspections or requirements apply
for fire alarm,plumbing, electrical, separate metering or any other
matters the Building Department may have for such a conversion within
the current town regulations. Are specific inspections by any of the town
inspectors required prior to certificates of occupancy being issued?
Please advise.
I am writing to you now since my clients want to avoid complications and
delays in obtaining certificates of occupancy once the conversion takes
place.
Thank you for your time and attention to this matter.
Yours truly
3ex , �"Y/
Lynda� _ ar/a
cc: Michel/McHugh/Dorr/Olson
93-95 Pleasant Street
North Andover, MA 01845
RECEIVED
DEL; 2 0,200,
BUILDING DEP-r.
N2 2M
0
Date .......
TOWN OF NORTH ANDOVER ff
PERMIT FOR WIRING
8
Ki
This certifies that ........ (�� ............................. 11
....................
has permission to perform
wiring in the building of,...! .. .............................................
at ...... Z - CU
4 ..................... ....... . North Andover, Mass.
Fee.�� ... . ......... Lic. No� ......... .. . ...............................................................
EL;EcrRicAL INSPECMR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Office Use only
TAFC0MM0NWE4LTH0FARMCffV5=
DEPARTAONTOMALICS4MY Pentut No.
BOARI)OFFD?EPREVEMONREGUL4TIOAS527CWR 120
/ Occupancy & Fees Checked
APPLICATIONFORPERNff TOPEDUFORMMa WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELEC-MCAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) D at"/
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 112 e Of
9�� As
Owner or Tenant 1:��e-k' c)/ -s -,mJ
Owner's Address 3 747 775 77-77
Is this permit in conjunction with a building permit: Yes No 1Z3— (Check Appropriate Box)
Purpose of Building Utility Authorization No.lq
��g --LirSi
Existing Service Amps Volts Overhead Underground No. of Meters
New Service Amps Volts Overhead Underground No, of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
M
mlwi-�
11�1c_ 140-L —Jr,
No. of Lighting Outlets
No. of Hot Tubs
No. offranisformers
Total
KVA
.No. ofLighting Fixtures
Swimming Pool Above
Below
Generators
KVA
ground
[3
ground
No. of Receptacle Outlets
I
No. ofOil Burners
No. ofEmergency Lighting Battery Un its
INo. of Switch Outlets
No. of Gas B umers
FIRE ALARMS
No. ofZones
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. ofDishwashers
Space Area Heating KW
No. ofSelfContained
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
E] Connections
-No. ofWater Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER 5
AN M
Work iD Stat �2 / ql'7 fiqxrtimDa1eRa*xsted Rao
E1irrgkdVakxafE3ec6aWcik$ �t 501)
Final P,/, 4e—
FIRM NAME A / "I'd 7
e- Lio=Nh /-7/
Sign�
&ZixssTCLNh C/ ?,e 17'e"
AWr,,— 9.5 74A -U,.3 /eV AIL Tel. Nh
OWMI�'SMJRANCEWAIVER;Iama%kmdodrlioamduesoo Cmmd Laws
and dritimy *Winonthits p=*Wpkahmwdr%cs this mWimnat
(Please check one) Owner 1:3 1 Agent ED
I elephone No. — rr-Kml I rr-r- I
TOWN OF NORTH ANDOVER
Location—
$
No.
Date
Z-7 1p
f
Building/Frame Permit Fee
$
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
f
Building/Frame Permit Fee
$
3 &
Fee
Foundation PerWi.,
$
C',
Other Permit Fe
Sewer Connection Fee
$
Water Connection Fee
$
33
TOTAL
$
Building Inspector
09/28/95
13:13 33.00 PAID
Div.
Public Works
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Date. --) Z—
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ....................
has permission to perform
..................................
plumbing in the buildings of
at ................ ............ North Andover, Mass.
z
Fee/ -'7' Lic. No ..........
TOR
Check #
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location 5 -
-S
Date
Permit
A -11"t 1 �2
Owner
'New Renovation [Er Replacement Plans Submitted Yes No
FIXTURES
W- F 1.3
75 in. ToTo"MI
0 Wj-1 vq FU r
ell
(�?rint or type) VO4 tq Check one: Certificate
Installing Company Name L/ u-(— 0 13-c- orp.
Address 10, pj-, �. r t � + , 4? El Partner.
(I—kA t -k u- rc-9 yti &4 cq�
Business Telephone * -)K 5'0 5 6 Firm/Co.
Name of Licensed Plumber: 'I ') �-(- 0
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 1:1 Other type of indemnity [—] 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
ignature Owner Agent
1:1 rl
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the MassacLsetts e P1 g Code and Chapter 142 of the General Laws.
By: .....
signat or 1-1censeu iriumDer
e of Plumbing License
Title ??
City/Town - Master B---- Journeyman
APPROVED (OFFICE USE ONLY
Location��-�I:s IA��,Aw sTf2EE-1
60?
No. Date
Check #
15 567 Buildin-g—Tnspector
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
MU
Building/Frame Permit Fee
$
162
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
162
Check #
15 567 Buildin-g—Tnspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVAT�� OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUELDING PERM[IT NUMBER: DATE ISSUED:
n4 a-..%
SIGNATURE:
Buildin Cornrnissioner/IpN�ector of Buildings Date
I SECTION I- SITE INFORMATION . J- � i
1. 1 Property Address:
q3jcv� PICA,540n+
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area tsf)
Frontage (R)
1.6 BUnDING SETBACKS (ft)
Front Yard
Side -Yard
Rear Yard
Required Provide
Required '13rolided
ReqLlired
Provided
So
1.7 Water ly M.G.L.C.40.. 54)
Public Ir Private 0
1.5. Flood Zone Information:
Zone Outside Flood Zone 0
1.9
Municipal
Sewerage Disposal Systern:
X On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSI-IIIP/AUTHORIIZED AGENT
2.1 Owner of Record
JA% ft,=� / W k-, AA % &ke cis s4-- fie A34_Jayct.- $A;4
N7# Print W Addriss for Service:
A A AAA
. /I/ -
., Signiture
2.2 Owner of Record:
-2,7,1
't Dorr— -q,5' t3p. &=�ew-,
Address for Service:
6,3/a —
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Wk%AVIA C. 069"V'I�j
Licensed Construction Supervisor:
I- Coo) rdA Dli,Ve, Amcwvay, MA 491010
dress
A A _C_A_� 7B1 95-7 - 81505-
�ignature e�) Telephone
3.2 Registered Home Improvement Contractor
)&A
AjLfl,�W&V' 0-04010VOhM
Company Name
Ito WcAvj C3*. �oz3l4jm,, "Ar oje)o I
Not Applicable 0
License Number
I I / oto / s"00+
Expirfition Dfate
Not Applicable - 0 .
111)01(a
Registration Number
Expiratidn Date
SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permi .
Signed affidavit Attached Yes ....... X No ....... 0
SECTION 5 Description o Proposed Work (check applicable)
New Construction 0 Existing Building 1A Repair(s) 0 Alterations(s) 0 Addition
Accessory Bldg. 0 E16molitibn, Ig Other 0 Specify
Brief Description of Proposed Work:
F -CAM 04C CA+ +-Vt C1 (;1 CIVIJ CA" S +Y V C,
CA -EWA -SI5 6 ISO df�ys�- ;: tok--Ar� ci-� sc-eeqd,
I SF.CTION 6 - FSTTMATRD CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Q
M'
Completed by RLmLut EMIic�
M�MMVX�M. �P
R,
Mn
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Constiuction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING PERMIT
0c,
1, Mk ye'� 66. 'as Own .--d fterre*of subject property
to act on
Hereby authorize
Teha in ill nirsn* 91 work ah
V t *eJ1 ding pennit application.
i'"
f
I & -
Aiwtlzi�; of own , , 1, �.�
er Date
SECTION'7b OWNER/AUTHORIZED AGENT DECLARATION
.1, WI�J%CAOA %&.VtV11�J as 44wner/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
W i, t I % a W�
Pr' t Name
A). C, 03
Si;n,qtiire of,14*Y&TilAgent Date
I NO. OF STORIES SIZE
BASENENT OR SLAB C ND
SIZE OF FLOOR TTMBERS 7- 16, 1-1�5 2 3kw
)SPAN 101
DMENSIONS OF SILLS (-L) I)vf- 16
DMENSIONS OF POSTS
I DMIENSIONS OF GIRDERS -X- AA I-,
�HEIGHT OF FOUNDATION 57 4'. iog I ow 042,4e) THICKNESS 14DU
'SIZEOFFOOTING IV *IL4- X
MATERIAL OF CHEVINEY Nvv-se I
IS BUILDING ON SOLID OR FILLED LAND
"IS BUILDING CONNECTED TO NATURAL GAS LINE
FORM U.- LOT RELEASE FORM
pAd
INbTRUCTIONS: 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 0C"VQ`t+101A '�010fiPrIIS PHONE
A vlckoje,41 -
W ( I I N avv% C - &0 0 y
LOCATION: Assessor's Map Numbe 7D PARCEL
SUBDIVISION LOT (S)
5
STREET93101s, ST. NUMBER
USE
ONLY
I RECOMMENDATIONS OF TOWN AGENTS: I
CONSE14VATION ADMINIpAATOR DATE APPROVED
DATE REJECTED
COMMENTS 00 VAIJ,5- /001,
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH -
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIO
ED
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECT
Revised 9\97 jm
.TE.67-0-b-07-
0
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number CS 079181
Birthdate: 11/06/1953
Expires: I 1 /06/2004 Tr. no: 79181
Restricted To:
WILLIAM C PENNY
2 COPLEY DRIVE
ANDOVER, MA 01810 Administrator
ANDOVEF
%L'Liw
110WINN
WOBURN, MA 01801
Board of Building Regulations and Standards
HOME IMAROVEMENT CONTRACTOR
Registratl o n —aI2 8016
vj�
--;-t - P. .vate Corporation
Administrator
7. c;
',k I A,= Iq, 560 6 � �- -t
#-- q f5
00
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PLAP
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E- , I"- 2z), A � �) U t , �2
c�
DJ.
EU
No 34613
�O
DWORD FORRELL
PROFESSIONAL LAND SURVEYOR
I 10 Winn Street
Suite 207 Phone: (781) 933-9012
Woburn, MA 01801 Fax: (781) 932-1174
lrX
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DwAPDj.
FARRREnLL
No 34613
10
\-4DWORD). FARRELL
I.,
PROFESSIONAL LAND SURVEYOR
110 Winn Street
Suite 207 Phone: (781) 933-9012
Woburn,MA01801 Fax: (781) 932-1174
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Worl<ers' Compensation Insurance Affidavit
Please Print
Name: A--AC�Tyev' tor—
Location: CU5
citv �jo- Phone
am 8 homeowner performilig all work myself.
F-1 I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for rriy employees working on this job.
Comparlyname: ADAAAveff
Address I A Vk
Cily: W0�1J1.1-vi 0 (2) Phone *7(81.0t�)7-08OS7
InsuranceCo. luo 01 Poligy # 1 0— 012-
Comggnv name:
Address
City: Phone #:
Failure to8ecure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,5W.00
and/or one years' imprisonment as well as civil penalties in the fonm of a STOP WORK ORDER and a fine of ($100.06) a day against me. I
understand that a copy of this statement may be forwarded to the Office of Invesbg?bons of the DIA for coverage verification.
I do herby certify under the pains and penalties of peilury that the information provk*d above is true and correct.
S
N
Official use only do not write in this area to be completed by city or town official'
FICheck If irnmediate response is required Building Dept
Contact person: Phone
FORM WORKMAN'S COMPENSATION
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Building Dept
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Licensing Board
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Selectman's Office
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Health Department
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Other
ENERGY CONSERVATION APPLICAT ION FORM FOR
LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS
780 CMR Appendix J (effective VIM)
A 1;t --ant Nnmo . Amr".,
Ile
cityrrown: A
Applicant Address: 110 WIVILA S+.
j0o6o �, %A AA A Q Use Group:
Date of Application: 0'2�_
Applicant Phone: =1 — C(3-7 Applicant Signature: -4, i
Comnliancc Path (check one): vul
Prescriptive Package (Limited to I- or 2 -family wood frame buildings heated with fossil fuels only)
Packa e (A through KK from Table J5.2. I b): Heating Degree Days (HDD,3) from Table J5.2. I a:
9
(For items d. through i., fill in all values that apply from Table -15.2. I b:)
a. Gross Wall Area -sq.fl f. Wall R -value R-
b. Glazing Area' sq. g. Floor R -value R -
c. Glazing % (100 x b + I a) % h. Basement wall R-
d. Glazing U -value U_ i. Slab Perimeter R-
e. Ceiling R -value _R- j. Heating AFUE
SiteAddress: Cl?'As,
Component Performance: "Manual Trade -Off", (Limited to wood or metal framed buildings only)
Climate Zone (from Figure J6.2.2) Zone 12 Zone 13 E] Zone 14
Attach Trade -'Off Worksheet from Appendix J, (and RVAC Trade -Off Worksheet, if applicable]
F-1 MAScheck Software
Attach Compliance Report and Inspection Checklist printouts.
C] Systems An'21ysLs OR C] Renewable Energy Sources
Attach Mass Registered Arch.itect or Engineer Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall + Ceiling Area �: �Osq.ft. b. Glazing Area' I f1j q.ft. c. Glazing% (100.xb�a)
0/6
ADDITION with Glazing % (c.) up to 400/6 —may use 780'CMR Table J 1. 1.23.1 below:
MAXIMUM 11-yalue -MINIMUM R -Values
Fenestration Ce-iling
I Wall
Floor
Basemen =all
Slab Perimeter, Depth
0-39 R-3
R-10, 4 ft
"SLTNROOM" addition (greater than 40% glazing -to -wall and ceiling gross area)
Attach "Consumer Information Form" from 780 CMR Appendix B.
Official's Name: Official's Signature:
Application Approved F� Denied Date of Approval/Denial:
Reason(s) for Denial: (provide additional details as.6eeded'on back side)
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COWEN ASSOCIATES
Consulting Structural Engineers
29 Vesta Road
NATICK, MASSACHUSETTS 01760
(508) 655-3976 FAX (508) 655-4284
cowenassoc.com
JOB 2, '? - m,- /4�" 6 /'/ /��- --s
SHEET NO. OF
CALCULATED BY DATE
CHECKED BY DATE
COWEN ASSOCIATES
Consulting Structural Engineers
1 29 Vesta Road
NATICK, MASSACHUSETTS 01760
(508) 655-3976 FAX (508) 655-4284
cowenassoc.com
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Consulting Structural Engineers SHEET NO. OF�
29 Vesta Road
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(508) 655-3976 FAX (508) 655-4284
cowenassoc.com CHECKED BY DATE
SCALE
COWEN ASSOCIATES
Consulting Structural Engineers
29 Vesta Road
NATICK, MASSACHUSETTS 01760
(508) 655-3976 FAX (508) 655-4284
cowenassoc.com
JOB '0� ;?, a , "'Ic-
SHEET NO,
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CALCULATED BY
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North Andover Building Department
Tel: 978-,688-9.4
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition Of Building Permit
Number - _-Q, 0 -is that the debris resulting from this work shall be
disposed of irt a properly licensed solid. waste disposal facili
C11,S150A. ty as. defined bY MGL
The debris will be disposed of in:
vt,. , K� . 9
(Location of Facili
Signature of Permit
Date
NOTE: Demolitio - n permit from ti�e Town of North Andover must be . obtained for
this project through the Office of the Building Inspector
it -i
Elm
51
N�z I W331124
BF30X121 33L REFRIG
BREAD DRAWER LID
B24/
21
6" SHADE ?
W/CROWN
TILT OUT TRAY
BCCJ3636/1 11339161134D161
DISH. 24"
-eOFW2730B W2630/13 W2630/13
93
300/A LAQUER
1/2" OVERLAY
P/B W/DOVETAIL
Ali dimensions & size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
NO DOORS
W/PIGEON
141
132P�6/213 I U 0 1 132P24/2
IW24�30/A W3014 1W2430J2B
36
BEADED PANEL UNDER
WALL CABINETS TO COUNTER
24L
Mt
331
126
30
3u
Dwg no.
This is an original design and must ANDOLSON Scale: m imum Design: 03/12/02
Date : 03r21102
not be released or copied unless ANDOVER RENO SOLU11ONS
applicable fee has been paid or job
order placed. 95 PLEASENT ST Designer
NO.ANDOVER
F�
�'A
Note: This dravving is an artistic
interpretation of the general
appearance of the floor plan. It is
not meant to be an exact rendition.
ANDOVER RENO SOLUTIONS
95 PLEASENT ST
no.
r�7
Note: This dravving is an artistic
interpretation of the general
appearance of the floor plan. It is
not meant to be an exact rendition.
ANDOVER RENO SOLUTIONS
95 PLEASENT ST
NO.ANDOVER
Dwg no.
Note: This dravving is an artistic ANUULZJUN Lhvg no.
interpretation of the general ANDOVER RENO SOLUTIONS
appearance of the floor plan. It is 95 PLEASENT ST
not meant to be an exact rendition. —
141
30
6" VALANCE W/CROWN
33
1000 W DOOR STYLE
12a SLAB W DRAWER HEADS
FRAMELESS WHITE
3000.
30
B30 _FB -4D181 B36
T3084�4]gl' @@@@0- 1 Cd -)Cd -)C&- I @@@
701 42
228
51
UNFINISHED BIRCH
DIS
H.
24"
B21 BSB
A36
36R
W4218
1151
1801
63
300/A LAQUER
1/2" OVERLAY
P/B W/DOVETAIL
All dimensions & size designations This is an original design and must ANDOLS@C Scale: ma)dmum Design: 03/12/02 Dwg no.
Date : 03121/02
given are subject to verification on not be released or copied unless ANDOVER RENO SOLUTIONS - -
job site and adjustment to fit job applicable fee has been paid or job 95 PLEASENT ST Designer
conditions. order placed. NO.ANDOVER
Note: This drawing is an artistic
interpretation of the general
appearance of the floor plan. It is
not meant to be an exact rendition.
ANDOVER RENO SOLUTIONS
95 PLEASENT ST
Dwg no.
COWEN ASSOCIATES
Consulting Structural Engineers
29 Vesta Road
NATICK, MASSACHUSETTS 01760
(508) 655-3976 FAX (508) 655-4284
cowenassoc.com
JOB mc
SHEET NO. OF
CALCULATED By -r'-. DATE
CHECKED BY DATE
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COWEN ASSOCIATES
Consulting Structural Engineers
29 Vesta Road
NATICK, MASSACHUSETTS 01760'
(508) 655-3976 FAX (508) 655-4284
cowenassoc.com
JOB
SHEET NO. 0
CALCULATED BY DATE
CHECKED BY DATE
SCALF
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IN
PRODUCT 2D4-1 (Smgle Sheets) 205.1 (Padded)
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COWEN ASSOCIATES
Consulting Structural Engineers
29 Vesta Road
1`4ATICK, MASSACHUSETTS 01760 -
(508) 655-3976 FAX (508) 655-4284
cowenassoc.com
JOB c X;�
SHEET NO. OF
CALCULATED BY DATE 2Z PZ! -
CHECKED BY
SCALE
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